MEDICARE: AKRON PEDIATRIC OPHTHALMOLOGY AND OPHTHALMIC PLASTIC SURGERY, 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	174400000X	Specialist	35035797	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	:	1710062013
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AKRON PEDIATRIC OPHTHALMOLOGY AND OPHTHALMIC PLASTIC SURGERY, INC

Provider Business Mailing Address
First Line	:	215 WEST BOWERY ST LEVEL II
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44308-1062
Country	:	US
Telephone Number	:	330-535-8000
Fax Number	:	330-553-2121

Provider Business Practice Location Address
First Line	:	215 WEST BOWERY ST LEVEL II
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44308-1062
Country	:	US
Telephone Number	:	330-535-8000
Fax Number	:	330-553-2121

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBERT ALAN BURNSTINE
Credential	:	MD
Telephone Number	:	330-535-8000

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	05/09/2019

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