Provider Demographics
NPI:1932367604
Name:EYE MEDICAL & SURGICAL ASSOC INC.
Entity type:Organization
Organization Name:EYE MEDICAL & SURGICAL ASSOC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OPHTHALMOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-884-7181
Mailing Address - Street 1:5500 RIDGE RD
Mailing Address - Street 2:#208
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-2394
Mailing Address - Country:US
Mailing Address - Phone:440-884-7181
Mailing Address - Fax:440-884-7738
Practice Address - Street 1:5500 RIDGE RD
Practice Address - Street 2:#208
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-2394
Practice Address - Country:US
Practice Address - Phone:440-884-7181
Practice Address - Fax:440-884-7738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.037510207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3027870Medicaid
OH=========0010OtherCIGNA
OH3027870Medicaid
OH=========001OtherMEDICAL MUTUAL
OH=========00OtherBUREAU OF WORKERS COMPENSATION
OH=========0010OtherCIGNA
OHD67753Medicare UPIN
OH=========026OtherCARESOURCE
OH0394989Medicaid
000000118992OtherANTHEM