MEDICARE: NORTH RIDGEVILLE EYE CARE INC

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	3430	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	:	1427015932
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH RIDGEVILLE EYE CARE INC

Provider Business Mailing Address
First Line	:	7079 AVON BELDEN RD
Second Line	:
City	:	NORTH RIDGEVILLE
State	:	OH
Zip	:	44039-3774
Country	:	US
Telephone Number	:	440-327-2020
Fax Number	:	440-327-5174

Provider Business Practice Location Address
First Line	:	7079 AVON BELDEN RD
Second Line	:
City	:	NORTH RIDGEVILLE
State	:	OH
Zip	:	44039-3774
Country	:	US
Telephone Number	:	440-327-2020
Fax Number	:	440-327-5174

Authorized Official
Title or Position	:	PRESIDENT OPTOMETRIST
Name	:	DR. CAROL A NOVAK
Credential	:	OD
Telephone Number	:	440-327-2020

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	01/28/2020

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