Provider Demographics
NPI:1508155326
Name:PRESTIGE VISION, LLC
Entity Type:Organization
Organization Name:PRESTIGE VISION, LLC
Other - Org Name:COHEN'S FASHION OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:AMEZIANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-577-7660
Mailing Address - Street 1:100 CAMBRIDGESIDE PL
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02141-2218
Mailing Address - Country:US
Mailing Address - Phone:617-577-7660
Mailing Address - Fax:617-577-7659
Practice Address - Street 1:100 CAMBRIDGESIDE PL
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02141-2218
Practice Address - Country:US
Practice Address - Phone:617-577-7660
Practice Address - Fax:617-577-7659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3651332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier