Organization
THE CLEVELAND CLINIC FOUNDATION
Active
Organization
THE CLEVELAND CLINIC FOUNDATION
Active
Other names
Cleveland Clinic Park Ave West
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY L. LONGVILLE (CHIEF ACCT OFFICER AND CONTROLLER)
(216) 636-7416
Entity
Organization
Contact information
Practice address
484 PARK AVE W, MANSFIELD, OH 44906-3118
(419) 525-0330
(419) 994-2612
Mailing address
6801 BRECKSVILLE RD STE 20, INDEPENDENCE, OH 44131-5062
(216) 636-4969
(216) 442-1272
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0899569
—
OH
Enumeration date
09/21/2005
Last updated
03/31/2022
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