Healthcare Provider Details

I. General information

NPI: 1780778530
Provider Name (Legal Business Name): AMERICAN EYEWEAR, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32313 VINE STREET
WILLOWICK OH
44095
US

IV. Provider business mailing address

32313 VINE STREET
WILLOWICK OH
44095
US

V. Phone/Fax

Practice location:
  • Phone: 440-943-6858
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberOH4720
License Number StateOH

VIII. Authorized Official

Name: PHILIP W TEKNIPP
Title or Position: PRESIDENT
Credential:
Phone: 440-943-6858