Provider Demographics
NPI:1144420035
Name:ESSILOR LABORATORIES OF AMERICA, INC.
Entity Type:Organization
Organization Name:ESSILOR LABORATORIES OF AMERICA, INC.
Other - Org Name:DUFFENS OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REAL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOULET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-496-4105
Mailing Address - Street 1:13515 N STEMMONS FWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-5765
Mailing Address - Country:US
Mailing Address - Phone:800-843-3937
Mailing Address - Fax:
Practice Address - Street 1:145 WABASH ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3943
Practice Address - Country:US
Practice Address - Phone:800-657-5758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EOA HOLDING CO., INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-19
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier