=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679872659
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STYLE-EYES BY JENNIFER INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2011
-----------------------------------------------------
Last Update Date | 03/16/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 625 PARK AVE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10065-7326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-249-1976
-----------------------------------------------------
Fax | 212-249-3712
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 625 PARK AVE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10065-7326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-249-1976
-----------------------------------------------------
Fax | 212-249-3712
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. JENNIFER FRANCO CHAIKEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 212-249-1976
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 156FX1800X
-----------------------------------------------------
Taxonomy Name | Optician
-----------------------------------------------------
License Number | 5669
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------