Healthcare Provider Details

I. General information

NPI: 1164571774
Provider Name (Legal Business Name): MILETI OPTICAL COMPANY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 02/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5957 STATE RD
PARMA OH
44134-2868
US

IV. Provider business mailing address

5957 STATE RD
PARMA OH
44134-2868
US

V. Phone/Fax

Practice location:
  • Phone: 440-884-6333
  • Fax:
Mailing address:
  • Phone: 440-884-6333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number3064-S
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number01374
License Number StateOH

VIII. Authorized Official

Name: MARK ANTHONY MILETI
Title or Position: PRESIDENT
Credential:
Phone: 440-884-6333