Provider Demographics
NPI:1194067074
Name:KAWA, EDWARD ANTHONY SR (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:ANTHONY
Last Name:KAWA
Suffix:SR
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3972 WARRENSVILLE CENTER RD
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-6770
Mailing Address - Country:US
Mailing Address - Phone:216-751-9800
Mailing Address - Fax:216-491-9229
Practice Address - Street 1:3972 WARRENSVILLE CENTER RD
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-6770
Practice Address - Country:US
Practice Address - Phone:216-751-9800
Practice Address - Fax:216-491-9229
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS10284156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician