Provider Demographics
NPI:1952456667
Name:E.O. LAB INC.
Entity Type:Organization
Organization Name:E.O. LAB INC.
Other - Org Name:EYE OPENERS OPTICAL FASHIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:585-442-0123
Mailing Address - Street 1:2929 MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-4601
Mailing Address - Country:US
Mailing Address - Phone:585-442-0123
Mailing Address - Fax:585-442-1096
Practice Address - Street 1:2929 MONROE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-4601
Practice Address - Country:US
Practice Address - Phone:585-442-0123
Practice Address - Fax:585-442-1096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0858690001Medicare NSC