Provider Demographics
NPI:1831531599
Name:EYES ON HARLEM
Entity type:Organization
Organization Name:EYES ON HARLEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:CUDMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-893-0633
Mailing Address - Street 1:2507 HARLEM RD
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-4527
Mailing Address - Country:US
Mailing Address - Phone:716-893-0633
Mailing Address - Fax:716-893-0633
Practice Address - Street 1:2507 HARLEM RD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-4527
Practice Address - Country:US
Practice Address - Phone:716-893-0633
Practice Address - Fax:716-893-0633
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOBS EYES DOWNTOWN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000300015004OtherBLUE CROSS/BLUE SHIELD OF WESTERN NEW YORK