Healthcare Provider Details

I. General information

NPI: 1164401113
Provider Name (Legal Business Name): PAUL JOSEPH ALTON O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 02/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 OBERLIN AVE
LORAIN OH
44053-3115
US

IV. Provider business mailing address

4650 OBERLIN AVE
LORAIN OH
44053-3115
US

V. Phone/Fax

Practice location:
  • Phone: 440-282-9800
  • Fax: 440-282-1697
Mailing address:
  • Phone: 440-282-9800
  • Fax: 440-282-1697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3997
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: