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General NPI Number Information
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NPI Number | 1033584008
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Entity Type | Organization
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Legal Business Name | EYE ARMOR, INC.
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Dates
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Enumeration Date | 12/02/2015
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Last Update Date | 12/02/2015
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Provider Practice Location Address
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Address Line | 100 SPOTSYLVANIA MALL
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City | FREDERICKSBURG
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State | VA
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Zip | 22407
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Country | US
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Telephone | 540-289-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 30 BIG SPRING LANE
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City | STAFFORD
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State | VA
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Zip | 22554
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Country | US
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Telephone | 571-238-4096
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Fax | 540-657-4598
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOSEPH G. MATHERN JR.
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Credential | D.O.
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Telephone | 571-238-4096
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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 | 1101001797
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License Number State | VA
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