1235383498 NPI number — EYE STORE-SHOPPE LLC

Table of content: (NPI 1235383498)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235383498 NPI number — EYE STORE-SHOPPE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYE STORE-SHOPPE LLC
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:
JEFFREY KEHR SOLE MBR
Provider Other Organization Name Type Code:
5
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:
1235383498
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
222 E MAIN ST STE 114
Provider Second Line Business Mailing Address:
COLLEGEVILLE SHOPPING CENTER
Provider Business Mailing Address City Name:
COLLEGEVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19426-2650
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-489-4100
Provider Business Mailing Address Fax Number:
610-489-8458

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 E MAIN ST STE 114
Provider Second Line Business Practice Location Address:
COLLEGEVILLE SHOPPING CENTER
Provider Business Practice Location Address City Name:
COLLEGEVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19426-2650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-489-4100
Provider Business Practice Location Address Fax Number:
610-489-8458
Provider Enumeration Date:
11/13/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KEHR
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
610-489-4100

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 156FX1800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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