Provider Demographics
NPI:1386789584
Name:EXPRESSIONS IN EYEWEAR, INC
Entity type:Organization
Organization Name:EXPRESSIONS IN EYEWEAR, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:BLACKSTOCK
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:425-487-2744
Mailing Address - Street 1:14011 NE WOODINVILLE DUVALL RD
Mailing Address - Street 2:SUITE A-6
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-8504
Mailing Address - Country:US
Mailing Address - Phone:425-487-2744
Mailing Address - Fax:425-489-8562
Practice Address - Street 1:14011 NE WOODINVILLE DUVALL RD
Practice Address - Street 2:SUITE A-6
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-8504
Practice Address - Country:US
Practice Address - Phone:425-487-2744
Practice Address - Fax:425-489-8562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site