Provider Demographics
NPI:1164579546
Name:EYEGLASS ENTERPRISES INC.
Entity Type:Organization
Organization Name:EYEGLASS ENTERPRISES INC.
Other - Org Name:WORLD OF VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GLISKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-562-2020
Mailing Address - Street 1:530 21ST STREET
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-5450
Mailing Address - Country:US
Mailing Address - Phone:772-562-2020
Mailing Address - Fax:772-562-5874
Practice Address - Street 1:530 21ST ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5450
Practice Address - Country:US
Practice Address - Phone:772-562-2020
Practice Address - Fax:772-562-5874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4356332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1659447530Medicaid
FL1659447530Medicaid