Provider Demographics
NPI:1285333542
Name:SEDLACEK, MARY EILEEN
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:EILEEN
Last Name:SEDLACEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8303 W RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-5549
Mailing Address - Country:US
Mailing Address - Phone:440-884-5828
Mailing Address - Fax:440-884-5975
Practice Address - Street 1:8303 W RIDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5549
Practice Address - Country:US
Practice Address - Phone:440-884-5828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOP.005377-SC156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician