Provider Demographics
NPI:1972266310
Name:EYE DANCE AND SCREEN
Entity Type:Organization
Organization Name:EYE DANCE AND SCREEN
Other - Org Name:EYE DANCE AND SCREEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PRASHAW
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:315-755-6348
Mailing Address - Street 1:1218 ARSENAL ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-2214
Mailing Address - Country:US
Mailing Address - Phone:315-755-6348
Mailing Address - Fax:
Practice Address - Street 1:1218 ARSENAL ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-2214
Practice Address - Country:US
Practice Address - Phone:315-755-6348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:M B KAYANI PHYSICIAN PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty