Healthcare Provider Details

I. General information

NPI: 1518238559
Provider Name (Legal Business Name): DR SAYED HASAN OD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2012
Last Update Date: 01/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7640 MENTOR AVE
MENTOR OH
44060-5420
US

IV. Provider business mailing address

1524 SUMMERWOOD DR
BROADVIEW HEIGHTS OH
44147-2845
US

V. Phone/Fax

Practice location:
  • Phone: 440-942-3937
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4699
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number4699
License Number StateOH

VIII. Authorized Official

Name: DR. SAYED HASAN
Title or Position: PRESIDENT
Credential: OD
Phone: 440-521-1351