Provider Demographics
NPI:1952422081
Name:EYELAB
Entity type:Organization
Organization Name:EYELAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBER
Authorized Official - Middle Name:
Authorized Official - Last Name:BOJARSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-467-0969
Mailing Address - Street 1:12120A FAIRFAX TOWNE CTR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2876
Mailing Address - Country:US
Mailing Address - Phone:703-246-9596
Mailing Address - Fax:
Practice Address - Street 1:12120A FAIRFAX TOWNE CTR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-2876
Practice Address - Country:US
Practice Address - Phone:703-246-9596
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101 003357156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty