Provider Demographics
NPI:1982877007
Name:COMPUTEREYES.COM INC.
Entity Type:Organization
Organization Name:COMPUTEREYES.COM INC.
Other - Org Name:ULTRAVISION OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:I
Authorized Official - Last Name:GOGEL
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:954-972-9393
Mailing Address - Street 1:1311 LYONS RD
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33063-3927
Mailing Address - Country:US
Mailing Address - Phone:954-972-9393
Mailing Address - Fax:954-979-9303
Practice Address - Street 1:1311 LYONS RD
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33063-3927
Practice Address - Country:US
Practice Address - Phone:954-972-9393
Practice Address - Fax:954-979-9303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0004618332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1312560001Medicare NSC