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General NPI Number Information
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NPI Number | 1427312131
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Entity Type | Organization
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Legal Business Name | MAKEIDEA
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Dates
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Enumeration Date | 06/27/2012
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Last Update Date | 06/27/2012
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Provider Practice Location Address
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Address Line | 3170 FM 407 SUITE 405
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City | HIGHLAND VILLAGE
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State | TX
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Zip | 75077-7049
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Country | US
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Telephone | 940-241-7172
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Fax |
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Provider Business Mailing Address
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Address Line | 450 MARSHALL WAY
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City | LANTANA
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State | TX
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Zip | 76226-6592
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Country | US
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Telephone | 908-552-4726
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Fax |
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Authorized Official
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Title or Position | MANAGER/OWNER
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Name | DIPEN PATEL
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Credential |
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Telephone | 908-240-2872
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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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