Healthcare Provider Details

I. General information

NPI: 1487193652
Provider Name (Legal Business Name): FAIRVIEW EYE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2017
Last Update Date: 12/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26777 LORAIN RD STE 203
NORTH OLMSTED OH
44070-3226
US

IV. Provider business mailing address

21375 LORAIN RD
FAIRVIEW PARK OH
44126-2122
US

V. Phone/Fax

Practice location:
  • Phone: 440-734-4777
  • Fax: 440-734-0555
Mailing address:
  • Phone: 440-333-3060
  • Fax: 440-333-0273

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: JANENE WEILLS
Title or Position: REFERRAL COORDINATOR
Credential:
Phone: 440-333-3060