Provider Demographics
NPI:1386841898
Name:EYEGLASS WEARHOUSE
Entity Type:Organization
Organization Name:EYEGLASS WEARHOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHIFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-578-3011
Mailing Address - Street 1:10107 W OAKLAND PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-6917
Mailing Address - Country:US
Mailing Address - Phone:954-578-3010
Mailing Address - Fax:954-578-3011
Practice Address - Street 1:10107 W OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-6917
Practice Address - Country:US
Practice Address - Phone:954-578-3010
Practice Address - Fax:954-578-3011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5594640001Medicare ID - Type Unspecified