NPIMap

Organization Active NPI

Ophthalmology & Oculoplastic Surgery Inc

Doing business as Kellis Eye and Laser Center

  • Ophthalmology Physician
  • Chardon, OH
National Provider Identifier
1073713400
Registry record updated Jun 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
35060480 Issued in OH
Legal business name
OPHTHALMOLOGY & OCULOPLASTIC SURGERY INC
Doing business as
Kellis Eye and Laser Center
Practice address
150 7TH Ave
Suite 100
Chardon, OH 44024-2908
Phone
(440) 285-2020
Fax
(440) 285-8448
NPI assigned
Jul 24, 2007
Last updated
Jun 9, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Candice Davis
Title
Chief Revenue Cycle Officer
Phone
(916) 990-7590

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X 5012T188 OH
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X 35060480 OH Primary

Addresses

Primary practice location

150 7TH Ave
Suite 100
Chardon, OH 44024-2908

Mailing address

150 7TH Ave Ste 100
Chardon, OH 44024-2909
Phone (440) 285-2020

Other identifiers 2

IdentifierTypeStateIssuer
CG4745OtherOHRAILROAD MEDICARE
2841689MedicaidOH

Other names 1

  • Kellis Eye and Laser Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20090914000000 OH Part B Supplier - Clinic/Group Practice 1355247081 Receives reassigned benefits from 5 practitioners
Practice locations: Independence, OH; Poland, OH; Sandusky, OH; Warren, OH; Youngstown, OH; Chardon, OH
O20100930018140 OH DME Supplier - Physician - OptometristDME Supplier - Physician - OphthalmologyDME Supplier - Optician 1355247081 Practice locations: Chardon, OH

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Ophthalmology & Oculoplastic Surger150 7TH Ave, Chardon, OH 44024-2909(440) 285-2020 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses Accepts assignmentParticipating since Feb 17, 2000

National Provider Directory

National Provider Directory

Locations

8185 Washington St
Ste 4
Chagrin Falls, OH 44023
Phone (440) 543-0708

150 7th Ave
Ste 100
Chardon, OH 44024
Phone (440) 285-2020

22715 Fairview Center Dr
Fairview Park, OH 44126
Phone (330) 810-5797

1611 S Green Rd
Ste 306C
South Euclid, OH 44121
Phone (216) 382-8022

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1185235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780963200000",
    "number": "1073713400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 7TH AVE STE 100",
            "city": "CHARDON",
            "state": "OH",
            "postal_code": "440242909",
            "telephone_number": "440-285-2020",
            "fax_number": "440-285-8448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 7TH AVE",
            "address_2": "SUITE 100",
            "city": "CHARDON",
            "state": "OH",
            "postal_code": "440242908",
            "telephone_number": "440-285-2020",
            "fax_number": "440-285-8448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPHTHALMOLOGY & OCULOPLASTIC SURGERY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-24",
        "last_updated": "2026-06-09",
        "certification_date": "2026-06-09",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "CANDICE",
        "authorized_official_title_or_position": "CHIEF REVENUE CYCLE OFFICER",
        "authorized_official_telephone_number": "916-990-7590"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "OH",
            "license": "5012T188",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "OH",
            "license": "35060480",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CG4745",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2841689",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kellis Eye and Laser Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chardon, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.