Healthcare Provider Details

I. General information

NPI: 1447420187
Provider Name (Legal Business Name): PLEASANT VALLEY EYECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2008
Last Update Date: 09/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7630 BROADVIEW RD
PARMA OH
44134-6745
US

IV. Provider business mailing address

7630 BROADVIEW RD
PARMA OH
44134-6745
US

V. Phone/Fax

Practice location:
  • Phone: 216-642-5500
  • Fax:
Mailing address:
  • Phone: 216-642-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number3529
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number3529
License Number StateOH

VIII. Authorized Official

Name: GARY CRAPANZANO
Title or Position: PRESIDENT
Credential: O.D.
Phone: 216-642-5500