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FOUNTAIN ANTI-AGING NPI 1154834562


NPI Information

NPI: 1154834562
Provider Name: FOUNTAIN ANTI-AGING

Doing Business As: XRMD

Classification: Ophthalmology - 207W00000X
Entity Type: Organization
Address:
892 BEACH RD
LAKEWOOD, OH
ZIP 44107
Phone: (216) 233-8503
Get Directions

FOUNTAIN ANTI-AGING is an ophthalmology in Lakewood, OH. The provider is an ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses. FOUNTAIN ANTI-AGING NPI is 1154834562. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Xrmd.

The provider's business location address is:

892 BEACH RD
LAKEWOOD, OH
ZIP 44107-018
Phone: (216) 233-8503
Fax: (216) 373-0044

The provider's authorized official is George William Rozakis .
The authorized official title is Chairman and has the following contact phone number (216) 233-8503.

The enumeration date for this NPI number is 11/7/2017 and was last updated on 3/17/2018.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207W00000XOphthalmology243058-1NEW YORKYes
2207W00000XOphthalmologyG142755CALIFORNIANo
3207W00000XOphthalmology56673CONNECTICUTNo
4207W00000XOphthalmologyMD459908PENNSYLVANIANo

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
10655189MEDICAIDOHIO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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