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General NPI Number Information
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NPI Number | 1477603546
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Entity Type | Organization
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Legal Business Name | BRECKSVILLE OPTICIANS, INC
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 12/11/2012
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Provider Practice Location Address
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Address Line | 7640 CHIPPEWA RD
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City | BRECKSVILLE
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State | OH
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Zip | 44141-2310
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Country | US
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Telephone | 440-526-5565
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Fax |
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Provider Business Mailing Address
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Address Line | 7640 CHIPPEWA RD
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City | BRECKSVILLE
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State | OH
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Zip | 44141-2310
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Country | US
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Telephone | 440-526-5565
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Fax |
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Authorized Official
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Title or Position | PROPRIETOR OPTICIAN
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Name | MR. WALTER B PARIS
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Credential | L.D.O.
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Telephone | 440-526-5565
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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 | 4818SC
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License Number State | OH
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