MEDICARE: EYE CARE DOCTORS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2462/T475	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053308668
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE CARE DOCTORS

Provider Business Mailing Address
First Line	:	30184 EUCLID AVE
Second Line	:
City	:	WICKLIFFE
State	:	OH
Zip	:	44092-1655
Country	:	US
Telephone Number	:	440-943-3663
Fax Number	:	440-943-3664

Provider Business Practice Location Address
First Line	:	30184 EUCLID AVE
Second Line	:
City	:	WICKLIFFE
State	:	OH
Zip	:	44092-1655
Country	:	US
Telephone Number	:	440-943-3663
Fax Number	:	440-943-3664

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DONALD HARRIS
Credential	:	O.D.
Telephone Number	:	440-943-3663

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	08/22/2020

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