Provider Demographics
NPI:1063859734
Name:CAPITOL EYES INC.
Entity type:Organization
Organization Name:CAPITOL EYES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:ALLOUCHE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:202-347-9260
Mailing Address - Street 1:1201 F ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20004-1217
Mailing Address - Country:US
Mailing Address - Phone:202-347-9260
Mailing Address - Fax:202-347-9264
Practice Address - Street 1:1201 F ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20004-1217
Practice Address - Country:US
Practice Address - Phone:202-347-9260
Practice Address - Fax:202-347-9264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-04
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC70170857332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC075080800Medicaid