1194098079 NPI number — EYECARE & EYEWEAR INC.

Table of content: (NPI 1194098079)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194098079 NPI number — EYECARE & EYEWEAR INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYECARE & EYEWEAR INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TELLO
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194098079
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8 DAVISON PLZ
Provider Second Line Business Mailing Address:
1ST FLOOR
Provider Business Mailing Address City Name:
EAST ROCKAWAY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11518-1545
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-399-3099
Provider Business Mailing Address Fax Number:
347-772-3032

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8 DAVISON PLAZA
Provider Second Line Business Practice Location Address:
1ST FL
Provider Business Practice Location Address City Name:
EAST ROCKAWAY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11518-1545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-399-3099
Provider Business Practice Location Address Fax Number:
347-772-3032
Provider Enumeration Date:
02/22/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CALDERON
Authorized Official First Name:
VINCENTE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
347-717-4117

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  TUV 007143 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)