Healthcare Provider Details

I. General information

NPI: 1538168596
Provider Name (Legal Business Name): PETER E SFORZA JR. O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 03/25/2008
Certification Date:
Deactivation Date: 03/20/2006
Reactivation Date: 03/27/2006

III. Provider practice location address

514 N STATE ST
GIRARD OH
44420-1745
US

IV. Provider business mailing address

514 N STATE ST
GIRARD OH
44420-1745
US

V. Phone/Fax

Practice location:
  • Phone: 330-545-3000
  • Fax: 330-545-5390
Mailing address:
  • Phone: 330-545-3000
  • Fax: 330-545-5390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3968T1103
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: