Provider Demographics
NPI:1043340102
Name:EYEGLASS WORLD, LLC 68
Entity type:Organization
Organization Name:EYEGLASS WORLD, LLC 68
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-965-9110
Mailing Address - Street 1:3801 S CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-4140
Mailing Address - Country:US
Mailing Address - Phone:561-965-9110
Mailing Address - Fax:561-642-4063
Practice Address - Street 1:44 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3533
Practice Address - Country:US
Practice Address - Phone:312-527-9477
Practice Address - Fax:312-222-9558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier