Provider Demographics
NPI:1265861330
Name:EYETIQUE INC
Entity Type:Organization
Organization Name:EYETIQUE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-462-9818
Mailing Address - Street 1:2242 MURRAY AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-2308
Mailing Address - Country:US
Mailing Address - Phone:412-422-5300
Mailing Address - Fax:
Practice Address - Street 1:28699 CHAGRIN BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:WOODMERE
Practice Address - State:OH
Practice Address - Zip Code:44122
Practice Address - Country:US
Practice Address - Phone:216-514-3002
Practice Address - Fax:216-514-1483
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYETIQUE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-08
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty