Healthcare Provider Details

I. General information

NPI: 1063415867
Provider Name (Legal Business Name): PERRY EPSTEIN LDO
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: SOLON VALLEY OPTICAL

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34050 SOLON RD
SOLON OH
44139-2664
US

IV. Provider business mailing address

34050 SOLON RD
SOLON OH
44139-2664
US

V. Phone/Fax

Practice location:
  • Phone: 440-248-8535
  • Fax:
Mailing address:
  • Phone: 440-248-8535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number26 SC
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: