Provider Demographics
NPI:1316969330
Name:THE EYEWEAR GALLERY
Entity type:Organization
Organization Name:THE EYEWEAR GALLERY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HR MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANSOORI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-454-3937
Mailing Address - Street 1:1920 116TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3012
Mailing Address - Country:US
Mailing Address - Phone:425-454-3937
Mailing Address - Fax:425-646-5914
Practice Address - Street 1:1920 116TH AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3012
Practice Address - Country:US
Practice Address - Phone:425-454-3937
Practice Address - Fax:425-646-5914
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOWARD S BARNEBEY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-25
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00022352332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0422940002OtherMEDICARE NSC