Provider Demographics
NPI:1609075019
Name:EYE-WEAR GLASSES III INC
Entity Type:Organization
Organization Name:EYE-WEAR GLASSES III INC
Other - Org Name:BOCA OPTICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:MANDEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-368-5844
Mailing Address - Street 1:122 W PALMETTO PARK RD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-3828
Mailing Address - Country:US
Mailing Address - Phone:561-368-5844
Mailing Address - Fax:561-368-6681
Practice Address - Street 1:122 W PALMETTO PARK RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432
Practice Address - Country:US
Practice Address - Phone:561-368-5844
Practice Address - Fax:561-368-6681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1112332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0725650001Medicare NSC