Provider Demographics
NPI:1427051697
Name:HILLCREST-MAYFIELD EYE ASSOCIATES, INC.
Entity type:Organization
Organization Name:HILLCREST-MAYFIELD EYE ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:Y.
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:SHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-442-4330
Mailing Address - Street 1:6770 MAYFIELD RD
Mailing Address - Street 2:STE 338
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2299
Mailing Address - Country:US
Mailing Address - Phone:440-442-4330
Mailing Address - Fax:440-442-4695
Practice Address - Street 1:6770 MAYFIELD RD
Practice Address - Street 2:STE 338
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2299
Practice Address - Country:US
Practice Address - Phone:440-442-4330
Practice Address - Fax:440-442-4695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH580800207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========OtherTAXPAYER I.D. NUMBER
OH=========005OtherMEDICAL MUTUAL OF OHIO
OHHI9179442Medicare ID - Type UnspecifiedOHIO MEDICARE