Provider Demographics
NPI:1649443060
Name:EYE XAMZ
Entity type:Organization
Organization Name:EYE XAMZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAGOPIAN
Authorized Official - Suffix:IV
Authorized Official - Credentials:COT,CRA
Authorized Official - Phone:262-705-8947
Mailing Address - Street 1:7419 256TH AVE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:WI
Mailing Address - Zip Code:53168-9158
Mailing Address - Country:US
Mailing Address - Phone:262-705-8947
Mailing Address - Fax:262-586-0062
Practice Address - Street 1:7532 PERSHING BLVD
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-4316
Practice Address - Country:US
Practice Address - Phone:262-705-8947
Practice Address - Fax:262-586-0062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-07
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1202XEye and Vision Services ProvidersTechnician/TechnologistOptometric TechnicianGroup - Multi-Specialty