Healthcare Provider Details

I. General information

NPI: 1093610008
Provider Name (Legal Business Name): FUSION EYEWEAR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 HULST DR STE 714
MATAMORAS PA
18336-2115
US

IV. Provider business mailing address

111 HULST DR STE 714
MATAMORAS PA
18336-2115
US

V. Phone/Fax

Practice location:
  • Phone: 845-956-0270
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: ORLANDO LALLAVE
Title or Position: OWNER
Credential: OPTICIAN
Phone: 845-636-3250