Provider Demographics
NPI:1790110294
Name:EYE DESIRE INC.
Entity Type:Organization
Organization Name:EYE DESIRE INC.
Other - Org Name:EYES ON ATLANTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JO
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SZOZDA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-532-4275
Mailing Address - Street 1:7272 W ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-4238
Mailing Address - Country:US
Mailing Address - Phone:954-532-4275
Mailing Address - Fax:
Practice Address - Street 1:7272 W ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-4238
Practice Address - Country:US
Practice Address - Phone:954-532-4275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO3231332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier