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General NPI Number Information
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NPI Number | 1174667422
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Entity Type | Organization
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Legal Business Name | OPTOMETRIC ARTS INC
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 05/11/2010
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Provider Practice Location Address
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Address Line | 18216 SLOANE AVE
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City | LAKEWOOD
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State | OH
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Zip | 44107-3110
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Country | US
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Telephone | 216-521-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 29665 CEDAR RD
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City | MAYFIELD HEIGHTS
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State | OH
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Zip | 44124-4411
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Country | US
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Telephone | 216-521-2020
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SUSAN ROSS
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Credential | O.D.
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Telephone | 216-521-2020
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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 | 3491 T1509
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License Number State | OH
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