Healthcare Provider Details

I. General information

NPI: 1154520294
Provider Name (Legal Business Name): OCULAR SERVICES MANAGEMENT INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 03/24/2020
Certification Date: 03/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26927 DETROIT RD
WESTLAKE OH
44145-2370
US

IV. Provider business mailing address

26927 DETROIT RD
WESTLAKE OH
44145-2370
US

V. Phone/Fax

Practice location:
  • Phone: 440-892-5367
  • Fax: 440-249-5094
Mailing address:
  • Phone: 440-892-5367
  • Fax: 440-249-5094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4481T1137
License Number StateOH

VIII. Authorized Official

Name: DR. PETER VICTOR MOGYORDY
Title or Position: OWNER
Credential: O.D.
Phone: 440-892-5367