Provider Demographics
NPI:1073785796
Name:THE EYEGLASS SHOPPE OF MADISON, INC.
Entity Type:Organization
Organization Name:THE EYEGLASS SHOPPE OF MADISON, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ZICCARELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-377-7144
Mailing Address - Street 1:26 WAVERLY PL
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940-1807
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:26 WAVERLY PL
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940-1807
Practice Address - Country:US
Practice Address - Phone:973-377-7144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier