Provider Demographics
NPI:1386799179
Name:SHVETS, DMITRIY
Entity type:Individual
Prefix:
First Name:DMITRIY
Middle Name:
Last Name:SHVETS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5852 MAYFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2903
Mailing Address - Country:US
Mailing Address - Phone:440-684-0800
Mailing Address - Fax:440-684-9066
Practice Address - Street 1:5852 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2903
Practice Address - Country:US
Practice Address - Phone:440-684-0800
Practice Address - Fax:440-684-9066
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10 S156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2347197Medicaid