Provider Demographics
NPI:1295030930
Name:EYEGLASS LLC
Entity Type:Organization
Organization Name:EYEGLASS LLC
Other - Org Name:AFFORDABLE FAMILY EYEWEAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LAMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:LOD
Authorized Official - Phone:541-567-3790
Mailing Address - Street 1:1045 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-1338
Mailing Address - Country:US
Mailing Address - Phone:509-947-2490
Mailing Address - Fax:541-567-3791
Practice Address - Street 1:1045 N 1ST ST
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-1338
Practice Address - Country:US
Practice Address - Phone:541-567-3790
Practice Address - Fax:541-567-3791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADO00001575332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1679713184OtherNPI INDIVIDUAL