Healthcare Provider Details

I. General information

NPI: 1558367599
Provider Name (Legal Business Name): CINDY ANN PEZO OD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6433 MONROE ST
SYLVANIA OH
43560-1451
US

IV. Provider business mailing address

6433 MONROE ST
SYLVANIA OH
43560-1451
US

V. Phone/Fax

Practice location:
  • Phone: 419-885-5373
  • Fax: 419-885-0504
Mailing address:
  • Phone: 419-885-5373
  • Fax: 419-885-0504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4076
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: