Provider Demographics
NPI:1912275397
Name:EYEGLASS DEPOT OPTICAL
Entity Type:Organization
Organization Name:EYEGLASS DEPOT OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-777-7283
Mailing Address - Street 1:60 WILLOW PARK CTR
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-1001
Mailing Address - Country:US
Mailing Address - Phone:631-777-7283
Mailing Address - Fax:631-777-3329
Practice Address - Street 1:60 WILLOW PARK CTR
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-1001
Practice Address - Country:US
Practice Address - Phone:631-777-7283
Practice Address - Fax:631-777-3329
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIFFER PARTNERS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier