Basic Information
| Provider Information | |||||||||
| NPI: | 1730120791 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSITY OPHTHALMOLOGISTS,INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5910 LANDERBROOK DR | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | MAYFIELD HTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441246508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4406845829 | ||||||||
| FaxNumber: | 4404491555 | ||||||||
| Practice Location | |||||||||
| Address1: | 11100 EUCLID AVE | ||||||||
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| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441061736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2168443601 | ||||||||
| FaxNumber: | 4404491555 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HUANG | ||||||||
| AuthorizedOfficialFirstName: | SUBER | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 2168443601 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology | 152W00000X | X | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 0477872 | 05 | OH | MEDICAID | CA0769 | 01 | OH | RAILROAD MEDICARE | OTHER |