Provider Demographics
NPI:1124627278
Name:EYE LOVE EYES, LLC
Entity type:Organization
Organization Name:EYE LOVE EYES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COTTER
Authorized Official - Suffix:
Authorized Official - Credentials:ABO
Authorized Official - Phone:214-801-5313
Mailing Address - Street 1:4825 CAMP BOWIE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-4150
Mailing Address - Country:US
Mailing Address - Phone:817-731-4646
Mailing Address - Fax:
Practice Address - Street 1:4825 CAMP BOWIE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-4150
Practice Address - Country:US
Practice Address - Phone:817-731-4646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty