Provider Demographics
NPI:1619052685
Name:FOR EYES OPTICAL CO OF PENNSYLVANIA
Entity Type:Organization
Organization Name:FOR EYES OPTICAL CO OF PENNSYLVANIA
Other - Org Name:FOR EYES OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-557-9004
Mailing Address - Street 1:1111 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219-3531
Mailing Address - Country:US
Mailing Address - Phone:804-648-5620
Mailing Address - Fax:804-648-6114
Practice Address - Street 1:1111 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-3531
Practice Address - Country:US
Practice Address - Phone:804-648-5620
Practice Address - Fax:804-648-6114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0682000079Medicare NSC