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General NPI Number Information
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NPI Number | 1326236829
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Entity Type | Organization
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Legal Business Name | CASE OPTICAL OF EUCLID
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 02/04/2008
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Provider Practice Location Address
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Address Line | 26300 EUCLID AVE SUITE 116
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City | EUCLID
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State | OH
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Zip | 44132-3708
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Country | US
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Telephone | 216-261-3600
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Fax | 216-261-3601
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Provider Business Mailing Address
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Address Line | 26300 EUCLID AVE SUITE 116
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City | EUCLID
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State | OH
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Zip | 44132-3708
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Country | US
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Telephone | 216-261-3600
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Fax | 216-261-3601
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Authorized Official
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Title or Position | OWNER
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Name | MR. PHILLIP A. BASILE
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Credential | OPTICIAN
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Telephone | 216-261-3600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 1054-S
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License Number State | OH
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