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Organization

FOUNTAIN ANTI-AGING

Active
Other names
xRMD
Organization subpart
No

Provider details

NPI number
Authorized official
GEORGE WILLIAM ROZAKIS MD (CHAIRMAN)
(216) 233-8503
Entity
Organization

Contact information

Practice address
892 BEACH RD, LAKEWOOD, OH 44107-1018
(216) 233-8503
(216) 373-0044
Mailing address
892 BEACH RD, LAKEWOOD, OH 44107-1018
(216) 233-8503

Taxonomy

Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
243058-1
NY
207W00000X
Ophthalmology Physician
56673
CT
207W00000X
Ophthalmology Physician
G142755
CA
207W00000X
Ophthalmology Physician
MD459908
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0655189
OH
Enumeration date
11/07/2017
Last updated
03/17/2018
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