Provider Demographics
NPI:1437484086
Name:EXCLUSIVE EYEWEAR LLC
Entity Type:Organization
Organization Name:EXCLUSIVE EYEWEAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:DAMARIS
Authorized Official - Last Name:ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-596-9393
Mailing Address - Street 1:362 LIVINGSTON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-1028
Mailing Address - Country:US
Mailing Address - Phone:718-596-9393
Mailing Address - Fax:718-596-9699
Practice Address - Street 1:362 LIVINGSTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-1028
Practice Address - Country:US
Practice Address - Phone:718-596-9393
Practice Address - Fax:718-596-9699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-14
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier