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General NPI Number Information
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NPI Number | 1013225150
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Entity Type | Organization
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Legal Business Name | CLEVELAND VISION CENTER II LLC
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Dates
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Enumeration Date | 09/23/2010
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Last Update Date | 09/23/2010
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Provider Practice Location Address
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Address Line | 6204 BROOKPARK RD
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City | CLEVELAND
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State | OH
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Zip | 44129-1218
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Country | US
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Telephone | 216-351-6270
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Fax | 216-351-6130
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Provider Business Mailing Address
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Address Line | 6204 BROOKPARK RD
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City | CLEVELAND
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State | OH
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Zip | 44129-1218
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Country | US
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Telephone | 216-351-6270
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Fax | 216-351-6130
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Authorized Official
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Title or Position | OWNER
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Name | DR. PETER VICTOR MOGYORDY
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Credential | OD
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Telephone | 216-402-9175
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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 | 4481
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License Number State | OH
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