Provider Demographics
NPI:1245521210
Name:EYEWEAR ADDICTION CORP
Entity type:Organization
Organization Name:EYEWEAR ADDICTION CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUBRANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-254-0246
Mailing Address - Street 1:640 TRAVIS AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4870
Mailing Address - Country:US
Mailing Address - Phone:212-254-0246
Mailing Address - Fax:
Practice Address - Street 1:133 SECOND AVENUE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:OK
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-254-0246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270A00628600332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier