Provider Demographics
NPI:1609210392
Name:HIGHLAND FAMILY OPTICAL LLC
Entity Type:Organization
Organization Name:HIGHLAND FAMILY OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:CHERMAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEYKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-463-5792
Mailing Address - Street 1:9094 E MINERAL AVENUE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112
Mailing Address - Country:US
Mailing Address - Phone:303-797-0882
Mailing Address - Fax:303-790-4162
Practice Address - Street 1:9094 E MINERAL AVENUE
Practice Address - Street 2:SUITE 200
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112
Practice Address - Country:US
Practice Address - Phone:303-797-0882
Practice Address - Fax:303-790-4162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier