MEDICARE: JEROLD OPTICAL 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	156FX1800X	Optician	1267-S	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	:	1932247996
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEROLD OPTICAL INC.

Provider Business Mailing Address
First Line	:	800 HURON RD.
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44115-1121
Country	:	US
Telephone Number	:	216-781-7900
Fax Number	:	216-781-0554

Provider Business Practice Location Address
First Line	:	800 HURON RD E
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44115-1121
Country	:	US
Telephone Number	:	216-781-7900
Fax Number	:	216-781-0554

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. LISA ELLEN RUBIN
Credential	:	L.D.O.
Telephone Number	:	216-781-7900

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	07/06/2015

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Directions to “JEROLD OPTICAL INC. ” Practice Location

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