1861670572 NPI number — SHOPRITE DISCOUNT EYEGLASSES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861670572 NPI number — SHOPRITE DISCOUNT EYEGLASSES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHOPRITE DISCOUNT EYEGLASSES, 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:
EYEGLASS EMPORIUM
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:
1861670572
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
552 ARTHUR GODFREY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33140-3510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-621-1023
Provider Business Mailing Address Fax Number:
305-534-9214

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
552 ARTHUR GODFREY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33140-3510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-621-1023
Provider Business Practice Location Address Fax Number:
305-534-9214
Provider Enumeration Date:
02/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HULLMAN
Authorized Official First Name:
GEOFFREY
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
786-621-1023

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  DO504 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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