Healthcare Provider Details

I. General information

NPI: 1710970868
Provider Name (Legal Business Name): CLEVELAND EYE SPECIALISTS AND CONSULTANTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 S GREEN RD SUITE 306B
SOUTH EUCLID OH
44121-4128
US

IV. Provider business mailing address

1611 S GREEN RD SUITE 306B
SOUTH EUCLID OH
44121-4128
US

V. Phone/Fax

Practice location:
  • Phone: 216-291-3550
  • Fax: 216-291-4849
Mailing address:
  • Phone: 216-291-3550
  • Fax: 216-291-4849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID J MITCHELL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 216-291-3550