Provider Demographics
NPI:1609034008
Name:EYES BY LULU
Entity Type:Organization
Organization Name:EYES BY LULU
Other - Org Name:VISION WORLD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1845-623-4766
Mailing Address - Street 1:1013 NANUET MALL
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10954
Mailing Address - Country:US
Mailing Address - Phone:184-562-3416
Mailing Address - Fax:
Practice Address - Street 1:1013 NANUET MALL
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:NY
Practice Address - Zip Code:10954
Practice Address - Country:US
Practice Address - Phone:184-562-3416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
No305S00000XManaged Care OrganizationsPoint of Service