Provider Demographics
NPI:1093841165
Name:FOR EYES OPTICAL OF PA
Entity Type:Organization
Organization Name:FOR EYES OPTICAL OF PA
Other - Org Name:FOR EYES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-557-9004
Mailing Address - Street 1:285 W 74TH PL
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-5058
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:274 DANIEL WEBSTER HWY
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-5729
Practice Address - Country:US
Practice Address - Phone:603-888-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2013-10-01
Deactivation Date:2013-07-10
Deactivation Code:
Reactivation Date:2013-08-02
Provider Licenses
StateLicense IDTaxonomies
NH1029332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier