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NPI Code Detail

MEDICARE: ALICIA'S EYEWEAR BOUTIQUE

MEDICARE: ALICIA'S EYEWEAR BOUTIQUE
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
1156FX1800XOptician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1841376258
Entity Type Code : Organization
Provider Name (Legal Business Name) : ALICIA'S EYEWEAR BOUTIQUE
Provider Business Mailing Address
First Line : 10128 SAINT CLAIR AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44108-1963
Country : US
Telephone Number : 216-761-6055
Fax Number : 216-761-6056
Provider Business Practice Location Address
First Line : 10128 SAINT CLAIR AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44108-1963
Country : US
Telephone Number : 216-761-6055
Fax Number : 216-761-6056
Authorized Official
Title or Position : OWNER
Name : ALICIA FORD
Credential : OPTICIAN
Telephone Number : 216-761-6055
Provider Enumeration Date : 10/27/2006
Last Update Date : 06/13/2008

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1285041855 — RYAN FINKE
Practice Location Address:
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Directions to “ALICIA'S EYEWEAR BOUTIQUE ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.