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General NPI Number Information
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NPI Number | 1639478035
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Entity Type | Organization
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Legal Business Name | EYELASH VISION, LLC
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Dates
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Enumeration Date | 03/24/2011
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Last Update Date | 03/24/2011
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Provider Practice Location Address
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Address Line | 500 BROAD STREET SUITE 3
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City | COLLEGEVILLE
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State | PA
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Zip | 19426-4912
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Country | US
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Telephone | 610-831-1100
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Fax | 610-831-1108
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Provider Business Mailing Address
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Address Line | 855 RICHARDS RD
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City | WAYNE
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State | PA
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Zip | 19087-1043
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Country | US
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Telephone | 610-783-0301
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Fax | 610-831-1108
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Authorized Official
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Title or Position | PRESIDENT/MANAGING PARTNER
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Name | MS. MOJEH MOHTASHAMI
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Credential | STORE GEN. MANAGER
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Telephone | 610-831-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State | PA
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