Basic Information
| Provider Information | |||||||||
| NPI: | 1578892535 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EYEGLASS WORLD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 296 GRAYSON HWY | ||||||||
| Address2: | |||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300465737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708223600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 13534 BEACH BLVD STE 3 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322241204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043833400 | ||||||||
| FaxNumber: | 9043833405 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2009 | ||||||||
| LastUpdateDate: | 12/21/2009 | ||||||||
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| AuthorizedOfficialLastName: | EDICK | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MC ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 6788923774 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NATIONAL VISION, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 156FX1800X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Technician/Technologist | Optician |
No ID Information.