=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265446116
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROMANOFF OPTICAL, LTD.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2006
-----------------------------------------------------
Last Update Date | 08/25/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5300 HARROUN RD SUITE 112
-----------------------------------------------------
City | SYLVANIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43560-2182
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-882-5146
-----------------------------------------------------
Fax | 419-882-5209
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5300 HARROUN RD SUITE 112
-----------------------------------------------------
City | SYLVANIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43560-2182
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-882-5146
-----------------------------------------------------
Fax | 419-882-5209
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. HEDVA T ROMANOFF
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 419-882-5146
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number | 48173821
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------