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General NPI Number Information
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NPI Number | 1235383498
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Entity Type | Organization
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Legal Business Name | EYE STORE-SHOPPE LLC
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Dates
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Enumeration Date | 11/13/2008
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Last Update Date | 10/01/2010
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Provider Practice Location Address
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Address Line | 222 E MAIN ST STE 114 COLLEGEVILLE SHOPPING CENTER
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City | COLLEGEVILLE
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State | PA
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Zip | 19426-2650
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Country | US
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Telephone | 610-489-4100
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Fax | 610-489-8458
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Provider Business Mailing Address
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Address Line | 222 E MAIN ST STE 114 COLLEGEVILLE SHOPPING CENTER
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City | COLLEGEVILLE
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State | PA
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Zip | 19426-2650
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Country | US
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Telephone | 610-489-4100
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Fax | 610-489-8458
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Authorized Official
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Title or Position | OWNER
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Name | JEFFREY KEHR
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Credential |
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Telephone | 610-489-4100
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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