Provider Demographics
NPI:1518259407
Name:FACES EYEWEAR, INC
Entity Type:Organization
Organization Name:FACES EYEWEAR, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-993-0790
Mailing Address - Street 1:10 E COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-5756
Mailing Address - Country:US
Mailing Address - Phone:920-993-0790
Mailing Address - Fax:920-993-0790
Practice Address - Street 1:4155 N GALAXY DR STE 101
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-2728
Practice Address - Country:US
Practice Address - Phone:920-993-0790
Practice Address - Fax:920-993-0791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty