Provider Demographics
NPI:1144343336
Name:WESTERN RESERVE EYE CENTER, INC
Entity type:Organization
Organization Name:WESTERN RESERVE EYE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:ELLIOTT
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-331-3443
Mailing Address - Street 1:3100 WOOSTER RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-4164
Mailing Address - Country:US
Mailing Address - Phone:440-331-3443
Mailing Address - Fax:440-331-0832
Practice Address - Street 1:3100 WOOSTER RD
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-4164
Practice Address - Country:US
Practice Address - Phone:440-331-3443
Practice Address - Fax:440-331-0832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH047715174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCB8008OtherRAILROAD MEDICARE
OHCB8008OtherRAILROAD MEDICARE