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General NPI Number Information
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NPI Number | 1275512709
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Entity Type | Organization
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Legal Business Name | FAIRVIEW EYE CENTER, INC
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Dates
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Enumeration Date | 01/12/2006
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Last Update Date | 10/27/2016
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Provider Practice Location Address
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Address Line | 21375 LORAIN RD
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City | FAIRVIEW PARK
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State | OH
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Zip | 44126-2122
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Country | US
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Telephone | 440-333-7346
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Fax | 440-333-0273
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Provider Business Mailing Address
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Address Line | 21375 LORAIN RD
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City | FAIRVIEW PARK
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State | OH
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Zip | 44126-2122
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Country | US
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Telephone | 440-333-7346
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Fax | 440-333-0273
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Authorized Official
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Title or Position | PRESIDENT
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Name | THEODORE E LOIZOS
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Credential | MD
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Telephone | 440-333-7346
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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 | 556859
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 556859
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 556859
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License Number State | OH
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