Healthcare Provider Details

I. General information

NPI: 1053308668
Provider Name (Legal Business Name): EYE CARE DOCTORS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30184 EUCLID AVE
WICKLIFFE OH
44092-1655
US

IV. Provider business mailing address

30184 EUCLID AVE
WICKLIFFE OH
44092-1655
US

V. Phone/Fax

Practice location:
  • Phone: 440-943-3663
  • Fax: 440-943-3664
Mailing address:
  • Phone: 440-943-3663
  • Fax: 440-943-3664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2462/T475
License Number StateOH

VIII. Authorized Official

Name: DR. DONALD HARRIS
Title or Position: PRESIDENT
Credential: O.D.
Phone: 440-943-3663