Provider Demographics
NPI:1235804485
Name:FOUR YOUR EYES ONLY LLC
Entity Type:Organization
Organization Name:FOUR YOUR EYES ONLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMENICHELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-253-5484
Mailing Address - Street 1:517 WHITTIER HWY
Mailing Address - Street 2:
Mailing Address - City:MOULTONBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03254-3213
Mailing Address - Country:US
Mailing Address - Phone:603-253-5484
Mailing Address - Fax:603-253-5484
Practice Address - Street 1:517 WHITTIER HWY
Practice Address - Street 2:
Practice Address - City:MOULTONBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03254-3213
Practice Address - Country:US
Practice Address - Phone:603-253-5484
Practice Address - Fax:603-253-5484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty