MEDICARE: SURGICAL SUCCESS

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

General Provider Information

NPI Number	:	1760554992
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGICAL SUCCESS

Provider Business Mailing Address
First Line	:	28743 LINCOLN RD
Second Line	:
City	:	BAY VILLAGE
State	:	OH
Zip	:	44140-2131
Country	:	US
Telephone Number	:	440-871-2324
Fax Number	:	440-871-2324

Provider Business Practice Location Address
First Line	:	28743 LINCOLN RD
Second Line	:
City	:	BAY VILLAGE
State	:	OH
Zip	:	44140-2131
Country	:	US
Telephone Number	:	440-871-2324
Fax Number	:	440-871-2324

Authorized Official
Title or Position	:	OFFICE MANAGER CFO
Name	:	MRS. ANGELA I PELTAN
Credential	:
Telephone Number	:	440-871-2324

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	11/16/2009

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Directions to “SURGICAL SUCCESS ” Practice Location

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