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General NPI Number Information
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NPI Number | 1033100805
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Entity Type | Organization
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Legal Business Name | GOOD LOOKS EYEWEAR INC
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Dates
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Enumeration Date | 11/02/2005
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Last Update Date | 07/03/2013
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Provider Practice Location Address
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Address Line | 20215 ROUTE 19 SUITE 104
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City | CRANBERRY TWP
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State | PA
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Zip | 16066-6146
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Country | US
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Telephone | 724-772-9090
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Fax | 724-772-9160
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Provider Business Mailing Address
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Address Line | 105 BRANDT DR SUITE 300
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City | CRANBERRY TWP
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State | PA
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Zip | 16066-6437
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Country | US
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Telephone | 724-772-5474
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Fax | 724-772-5423
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Authorized Official
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Title or Position | OWNER PHYSICIAN
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Name | WILLIAM CLARK CHRISTIE
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Credential | MD
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Telephone | 724-772-5420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | MD037014E
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License Number State | PA
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