Healthcare Provider Details

I. General information

NPI: 1396681706
Provider Name (Legal Business Name): EYEGLASS WEARHOUSE1 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5711 MANGO LN
HILLIARD OH
43026-7657
US

IV. Provider business mailing address

5711 MANGO LN
HILLIARD OH
43026-7657
US

V. Phone/Fax

Practice location:
  • Phone: 614-795-6558
  • Fax:
Mailing address:
  • Phone: 614-795-6558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: MR. ELTJON SADIKU
Title or Position: OWNER
Credential: LDO
Phone: 614-795-6558