Provider Demographics
NPI:1538178405
Name:SHARON LOVELAND O.D., INC.
Entity type:Organization
Organization Name:SHARON LOVELAND O.D., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVELAND (AKA BOSNAR, MARRIED '04)
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:216-533-6875
Mailing Address - Street 1:PO BOX 533
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-0533
Mailing Address - Country:US
Mailing Address - Phone:216-533-6875
Mailing Address - Fax:
Practice Address - Street 1:223 MEADOWLANDS DRIVE
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024
Practice Address - Country:US
Practice Address - Phone:440-286-1518
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3298/ T787152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U76596Medicare UPIN
LO0888321Medicare ID - Type UnspecifiedINACTIVE/ EMPLOYEE OPMG