Provider Demographics
NPI:1740480631
Name:ESSILOR LABORATORIES OF AMERICA
Entity type:Organization
Organization Name:ESSILOR LABORATORIES OF AMERICA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR. VICE PRESIDENT, NATIONAL LABS
Authorized Official - Prefix:
Authorized Official - First Name:REAL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOULET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-496-4105
Mailing Address - Street 1:13515 N STEMMONS FWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-5765
Mailing Address - Country:US
Mailing Address - Phone:800-843-3937
Mailing Address - Fax:
Practice Address - Street 1:900 LYON ST
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-4233
Practice Address - Country:US
Practice Address - Phone:800-325-4676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EOA HOLDING CO., INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-19
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier