Provider Demographics
NPI:1760658702
Name:THE EYEGLASS PLACE
Entity Type:Organization
Organization Name:THE EYEGLASS PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARY MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:RECTOR
Authorized Official - Suffix:
Authorized Official - Credentials:RO
Authorized Official - Phone:276-236-4066
Mailing Address - Street 1:PO BOX 904
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-0904
Mailing Address - Country:US
Mailing Address - Phone:276-236-4066
Mailing Address - Fax:276-236-4066
Practice Address - Street 1:544 E STUART DR
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-2231
Practice Address - Country:US
Practice Address - Phone:276-236-4066
Practice Address - Fax:276-236-4066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101001399332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0429880001Medicare NSC