MEDICARE: CLEVELAND VISION CENTER 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	2614	OH

General Provider Information

NPI Number	:	1598934069
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEVELAND VISION CENTER INC

Provider Business Mailing Address
First Line	:	6204 BROOKPARK ROAD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44129-1218
Country	:	US
Telephone Number	:	216-351-6270
Fax Number	:	216-351-6130

Provider Business Practice Location Address
First Line	:	6204 BROOKPARK ROAD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44129-1218
Country	:	US
Telephone Number	:	216-351-6270
Fax Number	:	216-351-6130

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. JANE A DORSEY
Credential	:
Telephone Number	:	216-351-6270

Provider Enumeration Date	:	02/28/2008
Last Update Date	:	10/31/2008

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Directions to “CLEVELAND VISION CENTER INC ” Practice Location

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