Provider Demographics
NPI:1639478035
Name:EYELASH VISION, LLC
Entity type:Organization
Organization Name:EYELASH VISION, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MANAGING PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MOJEH
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHTASHAMI
Authorized Official - Suffix:
Authorized Official - Credentials:STORE GEN MANAGER
Authorized Official - Phone:610-831-1100
Mailing Address - Street 1:855 RICHARDS RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-1043
Mailing Address - Country:US
Mailing Address - Phone:610-783-0301
Mailing Address - Fax:610-831-1108
Practice Address - Street 1:500 BROAD STREET
Practice Address - Street 2:SUITE 3
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-4912
Practice Address - Country:US
Practice Address - Phone:610-831-1100
Practice Address - Fax:610-831-1108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty