Provider Demographics
NPI:1871678847
Name:FOR EYES OPTICAL CO. OF PENNSYLVANIA
Entity Type:Organization
Organization Name:FOR EYES OPTICAL CO. OF PENNSYLVANIA
Other - Org Name:FOR EYES OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-557-9004
Mailing Address - Street 1:509 N MILITARY HWY
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3646
Mailing Address - Country:US
Mailing Address - Phone:757-466-1116
Mailing Address - Fax:757-466-1346
Practice Address - Street 1:509 N MILITARY HWY
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3646
Practice Address - Country:US
Practice Address - Phone:757-466-1116
Practice Address - Fax:757-466-1346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009280600Medicaid
VA009280600Medicaid