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General NPI Number Information
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NPI Number | 1073896841
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Entity Type | Organization
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Legal Business Name | EYEWEAR UNIQUE LLC
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Dates
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Enumeration Date | 09/27/2011
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Last Update Date | 09/27/2011
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Provider Practice Location Address
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Address Line | 5345 ROUTE 30
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City | GREENSBURG
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State | PA
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Zip | 15601-7875
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Country | US
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Telephone | 907-347-1934
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Fax |
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Provider Business Mailing Address
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Address Line | 318 CHRISNER RD
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City | LIGONIER
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State | PA
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Zip | 15658-2304
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHAD D PERSONETT
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Credential | O.D.
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Telephone | 907-347-1934
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OE008287T
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License Number State | PA
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