Provider Demographics
NPI:1376029074
Name:EYES OPEN OPTICAL BOUTIQUE
Entity Type:Organization
Organization Name:EYES OPEN OPTICAL BOUTIQUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELISSEETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABREU CABALLERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-568-0707
Mailing Address - Street 1:4310 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-3728
Mailing Address - Country:US
Mailing Address - Phone:212-568-0707
Mailing Address - Fax:
Practice Address - Street 1:4310 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-3728
Practice Address - Country:US
Practice Address - Phone:212-568-0707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier