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General NPI Number Information
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NPI Number | 1205208907
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Entity Type | Organization
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Legal Business Name | EYE CHICKS, LLC.
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Dates
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Enumeration Date | 10/21/2015
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Last Update Date | 10/21/2015
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Provider Practice Location Address
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Address Line | 2714 MARCONI AVE
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City | SACRAMENTO
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State | CA
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Zip | 95821-4914
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Country | US
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Telephone | 916-489-1110
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Fax |
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Provider Business Mailing Address
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Address Line | 2714 MARCONI AVE
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City | SACRAMENTO
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State | CA
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Zip | 95821-4914
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Country | US
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Telephone | 916-489-1110
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | STEPHEN C FOURNIER
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Credential | MGR
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Telephone | 916-489-1110
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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 | SL5288
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License Number State | CA
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