Healthcare Provider Details

I. General information

NPI: 1255473005
Provider Name (Legal Business Name): MADISON EYE CARE ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/14/2015
Certification Date:
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 TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5484
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3207
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4481
License Number StateOH

VIII. Authorized Official

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