Provider Demographics
NPI:1306007711
Name:MEDLENS INNOVATIONS, INCORPORATED
Entity Type:Organization
Organization Name:MEDLENS INNOVATIONS, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:OLIN
Authorized Official - Last Name:BREECE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:540-636-7976
Mailing Address - Street 1:1325 PROGRESS RD
Mailing Address - Street 2:
Mailing Address - City:FRONT ROYAL
Mailing Address - State:VA
Mailing Address - Zip Code:22630-6425
Mailing Address - Country:US
Mailing Address - Phone:540-636-7976
Mailing Address - Fax:540-635-8846
Practice Address - Street 1:1325 PROGRESS RD
Practice Address - Street 2:
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-6425
Practice Address - Country:US
Practice Address - Phone:540-636-7976
Practice Address - Fax:540-635-8846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier