Provider Demographics
NPI:1083020689
Name:THE EYEGLASS LASS LLC
Entity Type:Organization
Organization Name:THE EYEGLASS LASS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SIOBHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-501-0611
Mailing Address - Street 1:277 STATE ST
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-6312
Mailing Address - Country:US
Mailing Address - Phone:860-574-9196
Mailing Address - Fax:
Practice Address - Street 1:277 STATE ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-6312
Practice Address - Country:US
Practice Address - Phone:860-574-9196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-03
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001744332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier