The Eye Site in Copley, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

5764 Issued in OH

Legal business name

THE EYE SITE IN COPLEY, LLC

Practice address

3612 Ridgewood Rd
Fairlawn, OH 44333

Phone

(330) 289-6206

Fax

(330) 668-0967

NPI assigned

Sep 9, 2008

Organization subpart

No

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

Authorized official

Name

Jennifer Hazelwood, OD

Title

Doctor/Owner

Phone

(330) 668-0150

Specialties & licenses 1

Addresses

Other names 1

• Hazelwood Vision Group LLC Former legal business name

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Locations

Practitioners 1

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

• Jennifer A Hazelwood Ugarte, OD

  • Optometrist
  • Fairlawn, OH
  • NPI 1801936638
  Medicare reassignment NPD

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

{
    "created_epoch": "1220918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623369600000",
    "number": "1205085628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3612 RIDGEWOOD RD",
            "city": "FAIRLAWN",
            "state": "OH",
            "postal_code": "44333",
            "telephone_number": "330-289-6206",
            "fax_number": "330-668-0967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3612 RIDGEWOOD RD",
            "city": "FAIRLAWN",
            "state": "OH",
            "postal_code": "44333",
            "telephone_number": "330-289-6206",
            "fax_number": "330-668-0967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE EYE SITE IN COPLEY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-09",
        "last_updated": "2021-06-11",
        "certification_date": "2021-06-11",
        "status": "A",
        "authorized_official_last_name": "HAZELWOOD",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "DOCTOR/OWNER",
        "authorized_official_telephone_number": "330-668-0150",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "OH",
            "license": "5764",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hazelwood Vision Group LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Optometrist in Fairlawn, OH
• Providers in Fairlawn, OH by specialty
• Optometrist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.