Provider Demographics
NPI:1497135784
Name:EYEBROW RENOVATION & PERMANENT MAKEUP
Entity Type:Organization
Organization Name:EYEBROW RENOVATION & PERMANENT MAKEUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:CPCP
Authorized Official - Phone:434-825-0481
Mailing Address - Street 1:100 2ND ST NW
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-5193
Mailing Address - Country:US
Mailing Address - Phone:434-825-0481
Mailing Address - Fax:
Practice Address - Street 1:100 2ND ST NW
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5193
Practice Address - Country:US
Practice Address - Phone:434-825-0481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1236000418261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center