Organization
OPHTHALMOLOGY & OCULOPLASTIC SURGERY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CANDICE DAVIS (CHIEF REVENUE CYCLE OFFICER)
(916) 990-7590
Entity
Organization
Contact information
Practice address
150 7TH AVE, SUITE 100, CHARDON, OH 44024-2908
(440) 285-2020
(440) 285-8448
Mailing address
150 7TH AVE STE 100, CHARDON, OH 44024-2909
(440) 285-2020
(440) 285-8448
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
5012T188
OH
207W00000X
Ophthalmology Physician
Primary
35060480
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2841689
—
OH
01
—
CG4745
RAILROAD MEDICARE
OH
Enumeration date
07/24/2007
Last updated
09/30/2025
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