Provider Demographics
NPI:1346426988
Name:DAWN'S EYEWEAR
Entity Type:Organization
Organization Name:DAWN'S EYEWEAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:A
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-229-3992
Mailing Address - Street 1:639 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-5482
Mailing Address - Country:US
Mailing Address - Phone:732-229-3992
Mailing Address - Fax:732-229-4102
Practice Address - Street 1:639 BROADWAY
Practice Address - Street 2:
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-5482
Practice Address - Country:US
Practice Address - Phone:732-229-3992
Practice Address - Fax:732-229-4102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00132500332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0898880001Medicare NSC
NJ1659448033Medicare UPIN