Healthcare Provider Details

I. General information

NPI: 1649949397
Provider Name (Legal Business Name): GLASSES 4 YOU LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 09/07/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 E HIGHWAY 82 STE 103
GAINESVILLE TX
76240-2268
US

IV. Provider business mailing address

905 E HIGHWAY 82 STE 103
GAINESVILLE TX
76240-2268
US

V. Phone/Fax

Practice location:
  • Phone: 561-275-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: JACKIE BENNETT
Title or Position: CREDENTIALING SUPERVISOR
Credential:
Phone: 561-433-6009