Provider Demographics
NPI:1831368901
Name:FASHION EYEWEAR
Entity type:Organization
Organization Name:FASHION EYEWEAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:EDNOR
Authorized Official - Middle Name:G
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-263-9470
Mailing Address - Street 1:916 LINCOLN WAY WEST
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17202
Mailing Address - Country:US
Mailing Address - Phone:717-263-9470
Mailing Address - Fax:
Practice Address - Street 1:916 LINCOLN WAY WEST
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17202
Practice Address - Country:US
Practice Address - Phone:717-263-9470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA283346OtherBLUECROSS BLUESHEILD
PA283346OtherBLUECROSS BLUESHEILD