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General NPI Number Information
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NPI Number | 1437484086
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Entity Type | Organization
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Legal Business Name | EXCLUSIVE EYEWEAR LLC
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Dates
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Enumeration Date | 10/14/2009
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Last Update Date | 10/20/2016
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Provider Practice Location Address
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Address Line | 362 LIVINGSTON ST
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City | BROOKLYN
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State | NY
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Zip | 11217-1028
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Country | US
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Telephone | 718-596-9393
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Fax | 718-596-9699
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Provider Business Mailing Address
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Address Line | 362 LIVINGSTON ST
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City | BROOKLYN
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State | NY
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Zip | 11217-1028
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Country | US
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Telephone | 718-596-9393
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Fax | 718-596-9699
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Authorized Official
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Title or Position | OWNER
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Name | MR. JESSICA DAMARIS ROSA
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Credential |
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Telephone | 718-596-9393
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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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