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NPI Code Detail

MEDICARE: KONDRAY OPTICAL LLC

MEDICARE: KONDRAY OPTICAL LLC
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
1332H00000XEyewear Supplier18-483106OH

General Provider Information

NPI Number : 1174524268
Entity Type Code : Organization
Provider Name (Legal Business Name) : KONDRAY OPTICAL LLC
Provider Business Mailing Address
First Line : 12000 MCCRACKEN RD
Second Line : STE 101
City : GARFIELD HTS
State : OH
Zip : 44125-2964
Country : US
Telephone Number : 216-581-0470
Fax Number : 216-581-0474
Provider Business Practice Location Address
First Line : 12000 MCCRACKEN RD
Second Line : STE 101
City : GARFIELD HTS
State : OH
Zip : 44125-2964
Country : US
Telephone Number : 216-581-0470
Fax Number : 216-581-0474
Authorized Official
Title or Position : OWNER
Name : ILDIKO T KONDRAY
Credential : MD
Telephone Number : 216-581-0470
Provider Enumeration Date : 08/10/2005
Last Update Date : 03/28/2008

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Directions to “KONDRAY OPTICAL LLC ” Practice Location

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