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General NPI Number Information
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NPI Number | 1396078028
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Entity Type | Organization
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Legal Business Name | EYES R US LLC
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Dates
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Enumeration Date | 09/14/2009
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Last Update Date | 09/14/2009
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Provider Practice Location Address
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Address Line | 5003 BERGENLINE AVE
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City | WEST NEW YORK
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State | NJ
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Zip | 07093
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Country | US
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Telephone | 201-420-1222
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Fax | 201-420-1369
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Provider Business Mailing Address
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Address Line | 5003 BERGLINE AVE
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City | WEST NEW YORK
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State | NJ
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Zip | 07093-5600
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Country | US
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Telephone | 201-420-1222
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Fax | 201-420-1369
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Authorized Official
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Title or Position | OWNER
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Name | MUKUL C RAITHATHA
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Credential |
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Telephone | 201-428-7336
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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 | 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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