Provider Demographics
NPI:1992003214
Name:EAGLES OPTICAL INC
Entity Type:Organization
Organization Name:EAGLES OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:YEUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-358-8518
Mailing Address - Street 1:4128 MAIN ST
Mailing Address - Street 2:#7
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3177
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4128 MAIN ST
Practice Address - Street 2:#7
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3177
Practice Address - Country:US
Practice Address - Phone:718-358-8518
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT002836-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty