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General NPI Number Information
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NPI Number | 1013116201
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Entity Type | Organization
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Legal Business Name | NORTH COAST OPTICAL
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Dates
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Enumeration Date | 07/17/2007
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Last Update Date | 12/03/2007
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Provider Practice Location Address
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Address Line | 6380 N RIDGE RD
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City | MADISON
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State | OH
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Zip | 44057-2548
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Country | US
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Telephone | 440-428-2172
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Fax | 440-428-8677
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Provider Business Mailing Address
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Address Line | 6380 N RIDGE RD
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City | MADISON
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State | OH
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Zip | 44057-2548
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Country | US
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Telephone | 440-428-2172
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Fax | 440-428-8677
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Authorized Official
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Title or Position | OWNER
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Name | MR. MARK A BASHORE
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Credential | O.D.
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Telephone | 440-428-2172
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4001
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License Number State | OH
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