Provider Demographics
NPI:1114114741
Name:WISE EYES CORP
Entity Type:Organization
Organization Name:WISE EYES CORP
Other - Org Name:EYEGLASS HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:LERNER
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:516-931-0110
Mailing Address - Street 1:10 WASHINGTON AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-4045
Mailing Address - Country:US
Mailing Address - Phone:516-931-0110
Mailing Address - Fax:
Practice Address - Street 1:10 WASHINGTON AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4045
Practice Address - Country:US
Practice Address - Phone:516-931-0110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5062332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0186160001Medicare NSC