Provider Demographics
NPI:1811027584
Name:EYEWEAR AT THE HAMPTONS
Entity Type:Organization
Organization Name:EYEWEAR AT THE HAMPTONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V PRES SECY CO FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAKAB
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:216-514-3322
Mailing Address - Street 1:27040 CEDAR RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:216-514-3322
Mailing Address - Fax:216-514-3323
Practice Address - Street 1:27040 CEDAR RD
Practice Address - Street 2:SUITE 109
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122
Practice Address - Country:US
Practice Address - Phone:216-514-3322
Practice Address - Fax:216-514-3323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS3787156FX1800X
OHS6582156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1133930001Medicare NSC