Provider Demographics
NPI:1841314549
Name:EYE FASHION FACTORY
Entity type:Organization
Organization Name:EYE FASHION FACTORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DOBYNES
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:314-389-2425
Mailing Address - Street 1:5800 NATURAL BRIDGE
Mailing Address - Street 2:
Mailing Address - City:STLOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63120
Mailing Address - Country:US
Mailing Address - Phone:314-389-2425
Mailing Address - Fax:314-389-7654
Practice Address - Street 1:5800 NATURAL BRIDGE
Practice Address - Street 2:
Practice Address - City:STLOUIS
Practice Address - State:MO
Practice Address - Zip Code:63120
Practice Address - Country:US
Practice Address - Phone:314-389-2425
Practice Address - Fax:314-389-7654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO104451OtherEYE MED
MO22468OtherHEALTHCARE USA
MO0783140001Medicare ID - Type Unspecified