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General NPI Number Information
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NPI Number | 1821000753
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Entity Type | Organization
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Legal Business Name | WESTERN RESERVE EYE ASSOCIATES, INC.
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Dates
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Enumeration Date | 08/12/2006
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Last Update Date | 12/09/2014
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Provider Practice Location Address
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Address Line | 1155 STATE ROUTE 303
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City | STREETSBORO
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State | OH
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Zip | 44241-3969
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Country | US
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Telephone | 330-422-2020
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Fax | 330-422-0316
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Provider Business Mailing Address
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Address Line | 1155 STATE ROUTE 303
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City | STREETSBORO
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State | OH
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Zip | 44241-3969
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Country | US
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Telephone | 330-422-2020
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Fax | 330-422-0316
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SHARON R KERNIG
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Credential |
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Telephone | 330-422-2020
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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 | T1453
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | OH35046927R
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License Number State | OH
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