FOUNTAIN ANTI-AGING


Address: 892 Beach Rd, Lakewood, OH 44107-1018
Phone: 2162338503

FOUNTAIN ANTI-AGING (NPI# 1154834562) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1154834562
Entity Type Organization
Organization Name FOUNTAIN ANTI-AGING
Other Organization Name XRMD
Practice Address 892 Beach Rd
Lakewood
OH 44107-1018
Practice Telephone 2162338503
Practice Fax Number 2163730044
Mailing Telephone 2162338503
Enumeration Date 2017-11-07
Last Update Date 2018-03-17
Authorized Official Name GEORGE WILLIAM ROZAKIS (CHAIRMAN)
Authorized Official Telephone 2162338503
Authorized Official Credential MD
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 207W00000X Ophthalmology G142755 CA Allopathic & Osteopathic Physicians
N 207W00000X Ophthalmology 56673 CT Allopathic & Osteopathic Physicians
N 207W00000X Ophthalmology MD459908 PA Allopathic & Osteopathic Physicians
Y 207W00000X Ophthalmology 243058-1 NY Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
OH 0655189 05

Other Provider/Organization Names

Other Name Type Code
xRMD Doing Business As Name - Organization

Provider Secondary Practice Location

Address Telephone Number Fax Number
892 Beach Rd, Lakewood, OH 441071018 2162338503 2163730044

Office Location

Street Address 892 BEACH RD
City LAKEWOOD
State OH
Zip Code 44107-1018

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1326522210 Lawrence M Roth Social Worker 14701 Detroit Ave Ste 363, Lakewood, OH 44107 2018-09-18
1376065730 Fareeha Khan Internal Medicine 12540 Edgewater Drive, Apt 411, Lakewood, OH 44107 2017-07-07
1912433756 Julie Ann Foucher-urcuyo Family Medicine 14601 Detroit Ave, Fl 2, Lakewood, OH 44107 2017-05-11
1225563661 Elizabeth Ann Rainbolt Family Medicine 14601 Detroit Ave Fl 2, Lakewood, OH 44107 2017-04-24
1255882551 Kristen Murray Dietitian, Registered 14900 Detroit Ave Ste 207, Lakewood, OH 44107 2016-10-21
1265828131 David Thomas Jonke Dentist 15640 Madison Ave., Lakewood, OH 44107 2015-04-08
1760885941 Debra Watkins Home Health Aide 1510 Newman Ave Apt 406, Lakewood, OH 44107 2014-10-02
1396155198 Monica M Owen Occupational Therapist 9200 Biddulph Rd., Brooklyn, OH 44107 2014-05-01
1730512229 Marsha Elaine Favors Licensed Practical Nurse 1448 Lakeland Ave, Lakewood, OH 44107 2013-08-20
1508130006 Ruth Rachel Raciniewski Counselor 15200 Madison Avenue, Lakewood, OH 44107 2012-03-01
Find all providers in zip 44107

Taxonomy Information

Taxonomy Code 207W00000X
Grouping Allopathic & Osteopathic Physicians
Classification Ophthalmology

Taxonomy Definition

An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source]
- Additional Resources: American Board of Ophthalmology, 2007. http://www.abop.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Ophthalmology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1578030011 Invision Eyecare Specialists Ophthalmology 1 State Route 70, Lakewood, NJ 08701-5895 2018-11-01
1477064905 Nj Eye Consultants Ophthalmology 101 Prospect St Ste 102, Lakewood, NJ 08701-5003 2017-10-24
1740689728 Don Pearson Ophthalmology 6708 Bridgeport Way W, Lakewood, WA 98499-8115 2014-08-15
1386860575 Marvin Isaac Gordon Ophthalmology 3300 E South St Ste 207, Lakewood, CA 90805-4549 2007-04-17
1962446690 Jonathan Marc Barofsky Ophthalmology 1255 Route 70 Ste 31n, Lakewood, NJ 08701-5973 2006-06-15
1548219934 Gregory A Kouyoumdjian Ophthalmology 2766 S Wadsworth Blvd., Lakewood, CO 80227 2006-05-10
1720049588 Moshe M Rothkopf Ophthalmology 1195 Highway 70, Lakewood, NJ 08701-5946 2006-03-31
1164492591 Fairview Eye Center Ophthalmology 16400 Hilliard Rd, Lakewood, OH 44107-5610 2006-01-26
1003897729 Thomas P Cliffel Ophthalmology 14200 Madison Ave, Lakewood, OH 44107-4510 2005-11-09
1427054469 David R Benson Ophthalmology 5920 100th St Sw Ste 8, Lakewood, WA 98499-2751 2005-06-23
Find all providers in LAKEWOOD

Competitor

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City LAKEWOOD
Zip Code 44107

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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