Provider Demographics
NPI:1235223678
Name:THE EYEGLASS FACTORY
Entity Type:Organization
Organization Name:THE EYEGLASS FACTORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARRON
Authorized Official - Middle Name:O
Authorized Official - Last Name:MELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-636-2020
Mailing Address - Street 1:1211 N. SHENANDOAH AVE.
Mailing Address - Street 2:
Mailing Address - City:FRONT ROYAL
Mailing Address - State:VA
Mailing Address - Zip Code:22630
Mailing Address - Country:US
Mailing Address - Phone:540-636-2020
Mailing Address - Fax:540-636-1001
Practice Address - Street 1:1211 N. SHENANDOAH AVE.
Practice Address - Street 2:
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630
Practice Address - Country:US
Practice Address - Phone:540-636-2020
Practice Address - Fax:540-636-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101001610332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009280375Medicaid