Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Fountain Anti-Aging

Organization Ophthalmology Physician · NPI 1154834562

Fountain Anti-Aging is an Ophthalmology Physician in Lakewood, Ohio. Works from 2 locations. Licensed in California, Connecticut, New York and Pennsylvania.

Licensed in
CA, CT, NY, PA
In the registry since
2017
Specialties on file
4

Practice location Address checks out

892 Beach Rd
Lakewood, OH 44107-1018
Phone: (216) 233-8503
Fax: (216) 373-0044
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 892 Beach Rd, Lakewood, OH 44107-1018 — (216) 233-8503

Specialties & licences

Ophthalmology Physician (primary) Taxonomy 207W00000X · Licence 243058-1 (NY)
Ophthalmology Physician Taxonomy 207W00000X · Licence G142755 (CA)
Ophthalmology Physician Taxonomy 207W00000X · Licence 56673 (CT)
Ophthalmology Physician Taxonomy 207W00000X · Licence MD459908 (PA)

Record details

NPI number1154834562
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official George Rozakis — Chairman · (216) 233-8503
Other names Xrmd
NPI enumeratedNovember 7, 2017
Last updated in NPPESMarch 17, 2018
Mailing address892 Beach Rd, Lakewood, OH 44107-1018

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