Provider Demographics
NPI:1770915969
Name:MOBILE EYEWEAR SERVICES LLC
Entity type:Organization
Organization Name:MOBILE EYEWEAR SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-929-8900
Mailing Address - Street 1:11029 MILL CENTRE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-3275
Mailing Address - Country:US
Mailing Address - Phone:410-929-8900
Mailing Address - Fax:410-363-1979
Practice Address - Street 1:11029 MILL CENTRE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-3275
Practice Address - Country:US
Practice Address - Phone:410-929-8900
Practice Address - Fax:410-363-1979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier