Provider Demographics
NPI:1891788873
Name:ROBERT A. ENGEL OD, INC.
Entity type:Organization
Organization Name:ROBERT A. ENGEL OD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:440-552-3124
Mailing Address - Street 1:36120 SPICEBUSH LN
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-5062
Mailing Address - Country:US
Mailing Address - Phone:440-552-3124
Mailing Address - Fax:
Practice Address - Street 1:36120 SPICEBUSH LN
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-5062
Practice Address - Country:US
Practice Address - Phone:440-552-3124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5206152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9329341Medicare ID - Type Unspecified