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General NPI Number Information
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NPI Number | 1649323858
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Entity Type | Organization
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Legal Business Name | FOR EYES OPTICAL OF PA
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 10/01/2013
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Provider Practice Location Address
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Address Line | 11011 LEE HWY
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City | FAIRFAX
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State | VA
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Zip | 22030-5002
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Country | US
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Telephone | 703-591-1402
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Fax |
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Provider Business Mailing Address
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Address Line | 285 W 74TH PL
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City | HIALEAH
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State | FL
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Zip | 33014-5058
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. PHILIP WOLMAN
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Credential |
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Telephone | 305-557-9004
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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 | 1101003134
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License Number State | VA
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