Healthcare Provider Details

I. General information

NPI: 1518882422
Provider Name (Legal Business Name): MR. JOSE NIEVES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15050 HARRINGTON WAY
MIDDLEFIELD OH
44062-9211
US

IV. Provider business mailing address

15050 HARRINGTON WAY
MIDDLEFIELD OH
44062-9211
US

V. Phone/Fax

Practice location:
  • Phone: 440-632-0530
  • Fax: 440-632-0537
Mailing address:
  • Phone: 440-632-0530
  • Fax: 440-632-0537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number7431S
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: