=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386789691
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FOR EYES OPTICAL CO, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2007
-----------------------------------------------------
Last Update Date | 05/09/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 755 BETHELEHEM PIKE STE. 2
-----------------------------------------------------
City | MONTGOMERYVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18936
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-361-8593
-----------------------------------------------------
Fax | 215-361-8595
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 285 W 74TH PL
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33014-5058
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-557-9004
-----------------------------------------------------
Fax | 305-362-2885
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PHILIP WOLMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 800-325-3276
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OEG001188
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------