Provider Demographics
NPI:1063520765
Name:RAVENNA OPTICAL INC
Entity type:Organization
Organization Name:RAVENNA OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:TURKER
Authorized Official - Last Name:APAYDIN
Authorized Official - Suffix:
Authorized Official - Credentials:LDO SC
Authorized Official - Phone:330-297-1419
Mailing Address - Street 1:223 W MAIN ST
Mailing Address - Street 2:RAVENNA OPTICAL INC
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266
Mailing Address - Country:US
Mailing Address - Phone:330-297-1419
Mailing Address - Fax:330-296-2808
Practice Address - Street 1:223 W MAIN ST
Practice Address - Street 2:RAVENNA OPTICAL INC
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266
Practice Address - Country:US
Practice Address - Phone:330-297-1419
Practice Address - Fax:330-296-2808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0091387Medicaid