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General NPI Number Information
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NPI Number | 1497051163
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Entity Type | Organization
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Legal Business Name | THE EYEGLASS SHOPPE, INC.
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Dates
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Enumeration Date | 01/28/2011
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Last Update Date | 01/21/2019
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Provider Practice Location Address
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Address Line | 121 S CENTER AVE
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City | SOMERSET
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State | PA
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Zip | 15501-2031
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Country | US
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Telephone | 814-445-4495
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Fax | 814-445-6432
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Provider Business Mailing Address
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Address Line | 121 S CENTER AVE
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City | SOMERSET
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State | PA
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Zip | 15501-2031
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Country | US
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Telephone | 814-445-4495
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Fax | 814-445-6432
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DR. MICHAEL JOHN BROWNFIELD
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Credential | OD
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Telephone | 814-445-4495
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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 | OEG001664
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License Number State | PA
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