Provider Demographics
NPI:1942491501
Name:PERSONAL EYES OPTICAL LABORATORY COMPANY
Entity Type:Organization
Organization Name:PERSONAL EYES OPTICAL LABORATORY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, PARTNER LABS
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-496-4040
Mailing Address - Street 1:13515 N STEMMONS FWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-5765
Mailing Address - Country:US
Mailing Address - Phone:800-843-3937
Mailing Address - Fax:
Practice Address - Street 1:2455 XENIUM LN N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-3625
Practice Address - Country:US
Practice Address - Phone:763-559-8848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EOA HOLDING CO., INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier