Provider Demographics
NPI:1326364118
Name:GLAMEYE OPTICAL BOUTIQUE
Entity Type:Organization
Organization Name:GLAMEYE OPTICAL BOUTIQUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHUNDRO
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:903-259-6325
Mailing Address - Street 1:2719 LEE ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-4106
Mailing Address - Country:US
Mailing Address - Phone:903-259-6325
Mailing Address - Fax:903-259-6326
Practice Address - Street 1:2719 LEE ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-4106
Practice Address - Country:US
Practice Address - Phone:903-259-6325
Practice Address - Fax:903-259-6326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty