Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | S10284 | OH |
NPI | 1194067074 |
---|---|
Provider Name | Mr. Edward Anthony Kawa SR. |
First Address | Beachwood, OH 44122-6770 |
Second Address | Beachwood, OH 44122-6770 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2013 |
Last Update Date | 19/03/2013 |