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General NPI Number Information
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NPI Number | 1659456176
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Entity Type | Organization
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Legal Business Name | STYLISH EYES INC.
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 01/05/2012
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Provider Practice Location Address
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Address Line | 266D N. MAIN ST.
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City | KILMARNOCK
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State | VA
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Zip | 22482
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Country | US
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Telephone | 804-435-2620
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Fax | 804-435-2620
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Provider Business Mailing Address
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Address Line | 266D N. MAIN ST. P.O. BOX 369
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City | KILMARNOCK
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State | VA
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Zip | 22482
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Country | US
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Telephone | 804-435-2620
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Fax | 804-435-2620
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Authorized Official
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Title or Position | OWNER,OPTICIAN
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Name | MRS. PATRICIA H PRINCE
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Credential | AAS. B.S.
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Telephone | 804-435-2620
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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 | 1101001436
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License Number State | VA
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