Provider Demographics
NPI:1164550257
Name:EYESAVERS EYEWEAR INC
Entity Type:Organization
Organization Name:EYESAVERS EYEWEAR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAINELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-514-1865
Mailing Address - Street 1:11951 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-7619
Mailing Address - Country:US
Mailing Address - Phone:561-514-1865
Mailing Address - Fax:561-514-1855
Practice Address - Street 1:11951 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-7619
Practice Address - Country:US
Practice Address - Phone:561-514-1865
Practice Address - Fax:561-514-1855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL2073156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4697730001OtherDMERC
FLFL2073OtherEYEMED VISION CARE