Fountain Anti-Aging

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

243058-1 Issued in NY

Legal business name

FOUNTAIN ANTI-AGING

Practice address

892 Beach Rd
Lakewood, OH 44107-1018

Phone

(216) 233-8503

Fax

(216) 373-0044

NPI assigned

Nov 7, 2017

Organization subpart

No

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

Authorized official

Name

George William Rozakis, MDNPI 1023004983

Title

Chairman

Phone

(216) 233-8503

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• xRMD Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• George W Rozakis, MD

  • Ophthalmology Physician
  • Westlake, OH
  • NPI 1023004983
  NPD (past) Authorized official

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

{
    "created_epoch": "1510012800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1154834562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "892 BEACH RD",
            "city": "LAKEWOOD",
            "state": "OH",
            "postal_code": "441071018",
            "telephone_number": "216-233-8503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "892 BEACH RD",
            "city": "LAKEWOOD",
            "state": "OH",
            "postal_code": "441071018",
            "telephone_number": "216-233-8503",
            "fax_number": "216-373-0044"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "892 Beach Rd",
            "address_purpose": "LOCATION",
            "city": "Lakewood",
            "state": "OH",
            "postal_code": "441071018",
            "country_code": "US",
            "telephone_number": "216-233-8503",
            "fax_number": "216-373-0044",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FOUNTAIN ANTI-AGING",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-07",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "ROZAKIS",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "CHAIRMAN",
        "authorized_official_telephone_number": "216-233-8503",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "NY",
            "license": "243058-1",
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "CA",
            "license": "G142755",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "CT",
            "license": "56673",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "PA",
            "license": "MD459908",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0655189",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "xRMD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jacob Fletcher, M.D.
• Morgan Flowers, CCC-SLP
• Elizabeth Flynn, PT, DPT
• Jessica Fonce, MOT, OTR/L
• Emily Hope Forsgren, DC
• Morgan Foutz
• Andrew Paul Franko, M.D.
• Loni Marie Frantzich, RN
• Rachel Fullum, LMT
• Emily Gabitzsch, CGC

• Ophthalmology Physician in Lakewood, OH
• Providers in Lakewood, OH by specialty
• Ophthalmology Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.