Provider Demographics
NPI:1780863035
Name:JUNIOR EAGLE CORPORATION
Entity Type:Organization
Organization Name:JUNIOR EAGLE CORPORATION
Other - Org Name:LINWOOD OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHINIAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:201-461-0010
Mailing Address - Street 1:104 LINWOOD PLZ
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-3701
Mailing Address - Country:US
Mailing Address - Phone:201-461-0010
Mailing Address - Fax:201-461-4111
Practice Address - Street 1:104 LINWOOD PLZ
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-3701
Practice Address - Country:US
Practice Address - Phone:201-461-0010
Practice Address - Fax:201-461-4111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00416500332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4638130001Medicare NSC