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General NPI Number Information
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NPI Number | 1548443302
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Entity Type | Organization
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Legal Business Name | CHAGRIN VALLEY OPTOMETRISTS, INC
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Dates
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Enumeration Date | 12/14/2007
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Last Update Date | 11/18/2025
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Provider Practice Location Address
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Address Line | 16706 CHILLICOTHE RD STE 500
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City | CHAGRIN FALLS
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State | OH
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Zip | 44023-4573
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Country | US
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Telephone | 440-708-0020
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Fax | 440-708-0302
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Provider Business Mailing Address
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Address Line | 16706 CHILLICOTHE RD STE 500
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City | CHAGRIN FALLS
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State | OH
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Zip | 44023-4573
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Country | US
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Telephone | 440-708-0020
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Fax | 440-708-0302
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Authorized Official
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Title or Position | BILLING
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Name | SUSAN WILSON
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Credential |
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Telephone | 440-708-0020
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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 | 3865
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License Number State | OH
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