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General NPI Number Information
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NPI Number | 1306469911
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Entity Type | Organization
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Legal Business Name | EYECONIC OPTICAL
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Dates
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Enumeration Date | 05/19/2020
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Last Update Date | 05/19/2020
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Provider Practice Location Address
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Address Line | 612 N DUPONT BLVD
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City | MILFORD
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State | DE
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Zip | 19963-1002
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Country | US
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Telephone | 106-462-1668
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Fax |
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Provider Business Mailing Address
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Address Line | 1069 W BIRDIE LN
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City | MAGNOLIA
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State | DE
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Zip | 19962-3111
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Country | US
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Telephone | 610-462-1668
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRIAN PIETRUSZEWSKI
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Credential |
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Telephone | 610-462-1668
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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 |
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License Number State |
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