Provider Demographics
NPI:1295338291
Name:GLAMOUR OPHTHALMIC DISPENSING PC
Entity type:Organization
Organization Name:GLAMOUR OPHTHALMIC DISPENSING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLOKANDOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-473-6699
Mailing Address - Street 1:2445 ARTHUR AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-6003
Mailing Address - Country:US
Mailing Address - Phone:917-473-6699
Mailing Address - Fax:
Practice Address - Street 1:2445 ARTHUR AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-6003
Practice Address - Country:US
Practice Address - Phone:917-473-6699
Practice Address - Fax:917-473-6697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty