Healthcare Provider Details

I. General information

NPI: 1053328708
Provider Name (Legal Business Name): CDS OPTICAL COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2141 MENTOR AVE
PAINESVILLE OH
44077-1323
US

IV. Provider business mailing address

2141 MENTOR AVE
PAINESVILLE OH
44077-1323
US

V. Phone/Fax

Practice location:
  • Phone: 440-354-3455
  • Fax: 440-354-6400
Mailing address:
  • Phone: 440-354-3455
  • Fax: 440-354-6400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. CARL SHIN
Title or Position: PRES.
Credential: MD
Phone: 440-354-3455