MEDICARE: JULIA WHITESIDE-DE VOS M.D.

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	207W00000X	Ophthalmology Physician	E-0146	AR
2	207W00000X	Ophthalmology Physician	G61894	CA
3	207W00000X	Ophthalmology Physician	35.080229	OH

General Provider Information

NPI Number	:	1083883888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA WHITESIDE-DE VOS M.D.

Provider Business Mailing Address
First Line	:	2984 BRIGHTON RD
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44120-1721
Country	:	US
Telephone Number	:	216-752-8044
Fax Number	:

Provider Business Practice Location Address
First Line	:	2984 BRIGHTON RD
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44120-1721
Country	:	US
Telephone Number	:	216-752-8044
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2008
Last Update Date	:	02/26/2008

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