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General NPI Number Information
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NPI Number | 1699320028
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Entity Type | Organization
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Legal Business Name | EYEGLASSES ONLINE DIRECT
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Dates
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Enumeration Date | 08/02/2019
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Last Update Date | 08/02/2019
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Provider Practice Location Address
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Address Line | 41975 BROOKVIEW LN
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-5227
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Country | US
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Telephone | 586-915-7465
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Fax |
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Provider Business Mailing Address
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Address Line | 41975 BROOKVIEW LN
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-5227
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Country | US
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Telephone | 586-915-7465
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Fax |
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | ANDREA MARIE NICHOLAS
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Credential | CERTIFIED OPTICIAN
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Telephone | 586-915-7465
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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 |
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License Number State |
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