Provider Demographics
NPI:1619136389
Name:EYEGLASSES ONE
Entity Type:Organization
Organization Name:EYEGLASSES ONE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:C
Authorized Official - Last Name:JILSON
Authorized Official - Suffix:
Authorized Official - Credentials:RDO
Authorized Official - Phone:508-778-2278
Mailing Address - Street 1:51 MAIN ST
Mailing Address - Street 2:STE 4
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3109
Mailing Address - Country:US
Mailing Address - Phone:508-778-2278
Mailing Address - Fax:
Practice Address - Street 1:51 MAIN ST
Practice Address - Street 2:STE 4
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3109
Practice Address - Country:US
Practice Address - Phone:508-778-2278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1204332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0230210001Medicare NSC