Provider Demographics
NPI:1053457077
Name:THE EYEGLASS STORE
Entity Type:Organization
Organization Name:THE EYEGLASS STORE
Other - Org Name:THE EYEGLASS STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:S
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:541-386-3937
Mailing Address - Street 1:114 CASCADE AVE
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-2306
Mailing Address - Country:US
Mailing Address - Phone:541-386-3937
Mailing Address - Fax:541-387-3132
Practice Address - Street 1:114 CASCADE AVE
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-2306
Practice Address - Country:US
Practice Address - Phone:541-386-3937
Practice Address - Fax:541-387-3132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier