Provider Demographics
NPI:1447550140
Name:HOMETOWN OPTICAL LLC
Entity type:Organization
Organization Name:HOMETOWN OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JEZEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-729-2293
Mailing Address - Street 1:8396 MAYFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44026-2522
Mailing Address - Country:US
Mailing Address - Phone:440-729-2293
Mailing Address - Fax:440-729-2296
Practice Address - Street 1:8396 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:CHESTERLAND
Practice Address - State:OH
Practice Address - Zip Code:44026-2522
Practice Address - Country:US
Practice Address - Phone:440-729-2293
Practice Address - Fax:440-729-2296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH332H00000X332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier