Provider Demographics
NPI:1790860815
Name:FOR EYES OPTICAL CO. OF PENNSYLVANIA
Entity Type:Organization
Organization Name:FOR EYES OPTICAL CO. OF PENNSYLVANIA
Other - Org Name:FOR EYES OPTICAL CO.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-557-9004
Mailing Address - Street 1:490 S LENOLA RD
Mailing Address - Street 2:
Mailing Address - City:MAPLE SHADE
Mailing Address - State:NJ
Mailing Address - Zip Code:08052-1618
Mailing Address - Country:US
Mailing Address - Phone:856-787-9660
Mailing Address - Fax:856-788-9754
Practice Address - Street 1:490 S LENOLA RD
Practice Address - Street 2:
Practice Address - City:MAPLE SHADE
Practice Address - State:NJ
Practice Address - Zip Code:08052-1618
Practice Address - Country:US
Practice Address - Phone:856-787-9660
Practice Address - Fax:856-788-9754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-02-26
Deactivation Date:2013-07-10
Deactivation Code:
Reactivation Date:2013-08-02
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0682000067Medicare NSC