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General NPI Number Information
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NPI Number | 1316969330
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Entity Type | Organization
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Legal Business Name | THE EYEWEAR GALLERY
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 04/01/2008
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Provider Practice Location Address
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Address Line | 1920 116TH AVE NE
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City | BELLEVUE
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State | WA
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Zip | 98004-3012
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Country | US
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Telephone | 425-454-3937
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Fax | 425-646-5914
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Provider Business Mailing Address
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Address Line | 1920 116TH AVE NE
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City | BELLEVUE
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State | WA
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Zip | 98004-3012
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Country | US
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Telephone | 425-454-3937
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Fax | 425-646-5914
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Authorized Official
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Title or Position | HR MANAGER
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Name | SUSAN MANSOORI
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Credential |
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Telephone | 425-454-3937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | MD00022352
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License Number State | WA
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