Provider Demographics
NPI:1255309027
Name:EYEGLASSES ETC CORP
Entity Type:Organization
Organization Name:EYEGLASSES ETC CORP
Other - Org Name:EYEGLASSES ETC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:B
Authorized Official - Last Name:WOLFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-828-8511
Mailing Address - Street 1:6304 SUNNYBROOK RD
Mailing Address - Street 2:
Mailing Address - City:FLOURTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19031-1639
Mailing Address - Country:US
Mailing Address - Phone:215-233-2272
Mailing Address - Fax:215-233-3661
Practice Address - Street 1:6304 SUNNYBROOK RD
Practice Address - Street 2:
Practice Address - City:FLOURTOWN
Practice Address - State:PA
Practice Address - Zip Code:19031-1639
Practice Address - Country:US
Practice Address - Phone:215-233-2272
Practice Address - Fax:215-233-3661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
393382OtherNATIONAL VISION ADM
91477OtherAETNA HMO
393009OtherNATIONAL VISION ADM
91477OtherAETNA HMO