Healthcare Provider Details

I. General information

NPI: 1144636499
Provider Name (Legal Business Name): NAVEEN MYSORE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 06/29/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2022 E 105TH ST
CLEVELAND OH
44106
US

IV. Provider business mailing address

9500 EUCLID AVE
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-5892
  • Fax: 216-445-7654
Mailing address:
  • Phone: 216-444-2200
  • Fax: 216-445-7654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35.123482
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License Number285683
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: