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General NPI Number Information
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NPI Number | 1578915385
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Entity Type | Organization
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Legal Business Name | SOPHIA K. FOTINOS O.D., LLC
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Dates
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Enumeration Date | 07/05/2016
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Last Update Date | 07/05/2016
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Provider Practice Location Address
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Address Line | 14553 MADISON AVE
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City | LAKEWOOD
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State | OH
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Zip | 44107-4325
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Country | US
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Telephone | 216-227-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 30233 CENTER RIDGE RD
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City | WESTLAKE
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State | OH
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Zip | 44145-5130
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Country | US
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Telephone | 440-829-4295
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF OPTOMETRY
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Name | SOPHIA FOTINOS
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Credential | O.D.
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Telephone | 216-227-2020
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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 | 6197
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License Number State | OH
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