Provider Demographics
NPI:1073020681
Name:EYESWEAR
Entity Type:Organization
Organization Name:EYESWEAR
Other - Org Name:UPTOWN EYESWEAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOULAY YOUNES
Authorized Official - Middle Name:
Authorized Official - Last Name:ELIDRISSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-250-8494
Mailing Address - Street 1:720 W LAKE ST # 107
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2963
Mailing Address - Country:US
Mailing Address - Phone:612-216-4705
Mailing Address - Fax:
Practice Address - Street 1:720 W LAKE ST # 107
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2963
Practice Address - Country:US
Practice Address - Phone:612-216-4705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-04
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery