Provider Demographics
NPI:1568830685
Name:BULLS EYE WEAR LTD. CO.
Entity Type:Organization
Organization Name:BULLS EYE WEAR LTD. CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MELITA
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:SCHAEFER
Authorized Official - Suffix:
Authorized Official - Credentials:ABOM
Authorized Official - Phone:406-552-1299
Mailing Address - Street 1:2910 S RESERVE ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-7676
Mailing Address - Country:US
Mailing Address - Phone:406-552-1299
Mailing Address - Fax:406-552-0118
Practice Address - Street 1:2910 S RESERVE ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-7676
Practice Address - Country:US
Practice Address - Phone:406-552-1299
Practice Address - Fax:406-552-0118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-05
Last Update Date:2015-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2015MSSGEN00229332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier