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General NPI Number Information
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NPI Number | 1891192019
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Entity Type | Organization
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Legal Business Name | CLEVELAND EYECARE, OD, PA
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Dates
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Enumeration Date | 12/03/2014
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Last Update Date | 12/03/2014
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Provider Practice Location Address
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Address Line | 422 W WARREN ST
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City | SHELBY
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State | NC
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Zip | 28150-5330
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Country | US
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Telephone | 704-482-1234
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Fax | 704-482-3777
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Provider Business Mailing Address
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Address Line | 422 W WARREN ST
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City | SHELBY
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State | NC
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Zip | 28150-5330
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Country | US
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Telephone | 704-482-1234
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Fax | 704-482-3777
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KRISTY HYDER
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Credential |
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Telephone | 704-482-1234
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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 | 1075
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License Number State | NC
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