Healthcare Provider Details

I. General information

NPI: 1497032833
Provider Name (Legal Business Name): NORTHERN OHIO EYE CONSULTANTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2011
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 E BROAD ST
ELYRIA OH
44035-6306
US

IV. Provider business mailing address

7001 S EDGERTON RD SUITE B
BRECKSVILLE OH
44141-4206
US

V. Phone/Fax

Practice location:
  • Phone: 440-366-6969
  • Fax: 440-366-9513
Mailing address:
  • Phone: 440-526-1974
  • Fax: 440-740-0662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5460T2372
License Number StateOH

VIII. Authorized Official

Name: DR. WILLIAM F WILEY
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 216-621-6132