Provider Demographics
NPI:1497704001
Name:FACTORY EYEGLASS OUTLET, INC.
Entity Type:Organization
Organization Name:FACTORY EYEGLASS OUTLET, INC.
Other - Org Name:FACTORY EYEGLASS/FINE EYEWEAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:GINSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-668-2885
Mailing Address - Street 1:2421 W HOLCOMBE BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1901
Mailing Address - Country:US
Mailing Address - Phone:713-668-2885
Mailing Address - Fax:713-668-3373
Practice Address - Street 1:2421 W HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1901
Practice Address - Country:US
Practice Address - Phone:713-668-2885
Practice Address - Fax:713-668-3373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDR0771332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5786260001OtherMEDICARE DME MAC