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General NPI Number Information
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NPI Number | 1689132797
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Entity Type | Organization
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Legal Business Name | THE CLEVELAND CLINIC FOUNDATION
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Dates
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Enumeration Date | 03/07/2019
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Last Update Date | 03/31/2022
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Provider Practice Location Address
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Address Line | 16215 MADISON AVE
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City | LAKEWOOD
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State | OH
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Zip | 44107-5618
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Country | US
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Telephone | 216-237-5888
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Fax | 216-521-3338
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Provider Business Mailing Address
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Address Line | 6801 BRECKSVILLE ROAD SUITE 20 RK2-7
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City | INDEPENDENCE
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State | OH
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Zip | 44131-5058
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Country | US
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Telephone | 216-636-8926
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Fax | 216-442-1272
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Authorized Official
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Title or Position | CHIEF ACCT OFFICER AND CONTROLLER
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Name | TIMOTHY L. LONGVILLE
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Credential |
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Telephone | 216-636-7416
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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