Provider Demographics
NPI:1033396858
Name:DAVE-JAVONNE INC.
Entity Type:Organization
Organization Name:DAVE-JAVONNE INC.
Other - Org Name:EUROVISION OPTICAL II
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HADDAD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:212-564-2112
Mailing Address - Street 1:107C W 37TH ST #C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-3606
Mailing Address - Country:US
Mailing Address - Phone:212-564-2112
Mailing Address - Fax:212-564-5060
Practice Address - Street 1:107 W 37TH ST # C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-3606
Practice Address - Country:US
Practice Address - Phone:212-564-2112
Practice Address - Fax:212-564-5060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV-007169332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWXZQQ1Medicare PIN