Provider Demographics
NPI:1912155417
Name:FASHION OPTIQUE
Entity Type:Organization
Organization Name:FASHION OPTIQUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:H
Authorized Official - Last Name:YOON
Authorized Official - Suffix:
Authorized Official - Credentials:RDO
Authorized Official - Phone:617-262-3145
Mailing Address - Street 1:710 COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215
Mailing Address - Country:US
Mailing Address - Phone:617-262-3145
Mailing Address - Fax:617-262-3475
Practice Address - Street 1:710 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-262-3145
Practice Address - Fax:617-262-3475
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FASHION OPTIQUE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS59787093156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty