Provider Demographics
NPI:1164751384
Name:YOUR EYES ON ME
Entity Type:Organization
Organization Name:YOUR EYES ON ME
Other - Org Name:NATALIES OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BANGIEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-329-0700
Mailing Address - Street 1:302 E FORDHAM RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-5008
Mailing Address - Country:US
Mailing Address - Phone:347-329-0700
Mailing Address - Fax:
Practice Address - Street 1:302 E FORDHAM RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5008
Practice Address - Country:US
Practice Address - Phone:347-329-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier