Provider Demographics
NPI:1659456176
Name:STYLISH EYES INC.
Entity Type:Organization
Organization Name:STYLISH EYES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER,OPTICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:H
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:AAS BS
Authorized Official - Phone:804-435-2620
Mailing Address - Street 1:266D N. MAIN ST.
Mailing Address - Street 2:P.O. BOX 369
Mailing Address - City:KILMARNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22482
Mailing Address - Country:US
Mailing Address - Phone:804-435-2620
Mailing Address - Fax:804-435-2620
Practice Address - Street 1:266D N. MAIN ST.
Practice Address - Street 2:
Practice Address - City:KILMARNOCK
Practice Address - State:VA
Practice Address - Zip Code:22482
Practice Address - Country:US
Practice Address - Phone:804-435-2620
Practice Address - Fax:804-435-2620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101001436156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0170100001Medicare ID - Type UnspecifiedOPTICIAN