Provider Demographics
NPI:1619139367
Name:EYEWEARHAUS, INC
Entity Type:Organization
Organization Name:EYEWEARHAUS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC
Authorized Official - Phone:314-567-7423
Mailing Address - Street 1:745 N NEW BALLAS RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6715
Mailing Address - Country:US
Mailing Address - Phone:314-567-7423
Mailing Address - Fax:314-567-7562
Practice Address - Street 1:745 N NEW BALLAS RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6715
Practice Address - Country:US
Practice Address - Phone:314-567-7423
Practice Address - Fax:314-567-7562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4635700001Medicare NSC