Provider Demographics
NPI:1972885994
Name:DR STEPHEN C SULYI OD LLC
Entity type:Organization
Organization Name:DR STEPHEN C SULYI OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SULYI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:864-884-7432
Mailing Address - Street 1:118 CHIMNEY RDG
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-4006
Mailing Address - Country:US
Mailing Address - Phone:864-884-7432
Mailing Address - Fax:864-688-2307
Practice Address - Street 1:118 CHIMNEY RDG
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024
Practice Address - Country:US
Practice Address - Phone:864-884-7432
Practice Address - Fax:864-688-2307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-15
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0212124Medicaid