Provider Demographics
NPI:1427537315
Name:COHEN FASHION OPTICAL, LLC
Entity Type:Organization
Organization Name:COHEN FASHION OPTICAL, LLC
Other - Org Name:PHILADELPHIA EYEGLASS LABS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:OSHEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-413-4186
Mailing Address - Street 1:100 QUENTIN ROOSEVELT BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-4843
Mailing Address - Country:US
Mailing Address - Phone:516-465-6905
Mailing Address - Fax:516-465-6980
Practice Address - Street 1:32 E GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19401-1512
Practice Address - Country:US
Practice Address - Phone:610-272-1440
Practice Address - Fax:610-272-1441
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COHEN FASHION OPTICAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA002985332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier