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General NPI Number Information
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NPI Number | 1407157761
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Entity Type | Organization
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Legal Business Name | GAIL A FEDAK OD INC
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Dates
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Enumeration Date | 11/03/2010
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Last Update Date | 01/21/2011
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Provider Practice Location Address
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Address Line | 70 N SAINT CLAIR ST #200
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City | PAINESVILLE
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State | OH
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Zip | 44077-3995
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Country | US
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Telephone | 440-352-3339
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Fax | 440-352-0013
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Provider Business Mailing Address
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Address Line | 70 N SAINT CLAIR ST #200
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City | PAINESVILLE
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State | OH
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Zip | 44077-3995
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Country | US
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Telephone | 440-352-3339
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Fax | 440-352-0013
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. GAIL A FEDAK
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Credential | O.D.
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Telephone | 440-352-3339
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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 | 3466
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License Number State | OH
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