Provider Demographics
NPI:1467781682
Name:PLAZA OPTICAL
Entity Type:Organization
Organization Name:PLAZA OPTICAL
Other - Org Name:EISENBREI'S PLAZA OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:EISENBREI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-492-0038
Mailing Address - Street 1:1130 30TH ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709-2921
Mailing Address - Country:US
Mailing Address - Phone:330-492-0038
Mailing Address - Fax:330-492-2914
Practice Address - Street 1:1130 30TH ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-2921
Practice Address - Country:US
Practice Address - Phone:330-492-0038
Practice Address - Fax:330-492-2914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier