Provider Demographics
NPI:1508955709
Name:ATTRACTIVE EYEWEAR INC
Entity Type:Organization
Organization Name:ATTRACTIVE EYEWEAR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:BRODOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-953-0233
Mailing Address - Street 1:37650 PROFESSIONAL CENTER DR
Mailing Address - Street 2:125 A
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-1139
Mailing Address - Country:US
Mailing Address - Phone:734-953-0233
Mailing Address - Fax:
Practice Address - Street 1:37650 PROFESSIONAL CENTER DR
Practice Address - Street 2:125 A
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-1139
Practice Address - Country:US
Practice Address - Phone:734-953-0233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0204450001Medicare NSC