Healthcare Provider Details

I. General information

NPI: 1649441783
Provider Name (Legal Business Name): THE CLEVELAND CLINIC FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

637 N UNION ST
LOUDONVILLE OH
44842-1074
US

IV. Provider business mailing address

6801 BRECKSVILLE RD STE 20, ATTN:DPC RK2-7
INDEPENDENCE OH
44131-5062
US

V. Phone/Fax

Practice location:
  • Phone: 419-994-4287
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DENNIS LARAWAY
Title or Position: EXECUTIVE VP CHIEF FINANCE OFFICER
Credential:
Phone: 216-445-1343