Provider Demographics
NPI:1083096143
Name:NUVUE OPTICAL BOUTIQUE, LLC
Entity Type:Organization
Organization Name:NUVUE OPTICAL BOUTIQUE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-962-2500
Mailing Address - Street 1:1395 FM 156 S
Mailing Address - Street 2:SUITE 107
Mailing Address - City:HASLET
Mailing Address - State:TX
Mailing Address - Zip Code:76052-4064
Mailing Address - Country:US
Mailing Address - Phone:817-962-2500
Mailing Address - Fax:817-210-4373
Practice Address - Street 1:1395 FM 156 S
Practice Address - Street 2:SUITE 107
Practice Address - City:HASLET
Practice Address - State:TX
Practice Address - Zip Code:76052-4064
Practice Address - Country:US
Practice Address - Phone:817-962-2500
Practice Address - Fax:817-210-4373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier