Provider Demographics
NPI:1306915178
Name:RAVAGNANI, JOSEPH A (OD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:A
Last Name:RAVAGNANI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8879 BRECKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141-1932
Mailing Address - Country:US
Mailing Address - Phone:440-526-3920
Mailing Address - Fax:440-526-6869
Practice Address - Street 1:8879 BRECKSVILLE RD
Practice Address - Street 2:
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141-1932
Practice Address - Country:US
Practice Address - Phone:440-526-3920
Practice Address - Fax:440-526-6869
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4223152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU47125Medicare UPIN
OH0754703Medicare PIN
OH0754704Medicare PIN