| Gregory Sasarak Inc | |
|
280 S Logan St Elyria OH 44035-6224 | |
| (440) 365-9311 | |
| (440) 366-5057 |
| Full Name | Gregory Sasarak Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 280 S Logan St, Elyria, Ohio |
| Authorized Official Name and Position | Gregory S Sasarak (OWNER) |
| Authorized Official Contact | 4403659311 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gregory Sasarak Inc 280 S Logan St Elyria OH 44035-6224 Ph: (440) 365-9311 | Gregory Sasarak Inc 280 S Logan St Elyria OH 44035-6224 Ph: (440) 365-9311 |
| NPI Number | 1710239991 |
|---|---|
| Provider Enumeration Date | 10/11/2012 |
| Last Update Date | 10/30/2012 |
| Medicare PECOS PAC ID | 9234380601 |
|---|---|
| Medicare Enrollment ID | O20121112000388 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710239991 | NPI | - | NPPES |
| 2642840 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 5592 (Ohio) | Primary |
| Provider Name | Gregory S Sasarak |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1457429508 PECOS PAC ID: 5991725061 Enrollment ID: I20051205000467 |
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