Healthcare Provider Details

I. General information

NPI: 1790738813
Provider Name (Legal Business Name): EXCELLENCE IN EYE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 10/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3609 MEDINA RD
MEDINA OH
44256-8181
US

IV. Provider business mailing address

3609 MEDINA RD
MEDINA OH
44256-8181
US

V. Phone/Fax

Practice location:
  • Phone: 330-722-1313
  • Fax: 330-723-3003
Mailing address:
  • Phone: 330-722-1313
  • Fax: 330-723-3003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: KRISTIN HARRIS
Title or Position: ADMINISTRATOR
Credential:
Phone: 330-722-1313