Provider Demographics
NPI:1427312131
Name:MAKEIDEA
Entity type:Organization
Organization Name:MAKEIDEA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIPEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-240-2872
Mailing Address - Street 1:450 MARSHALL WAY
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:TX
Mailing Address - Zip Code:76226-6592
Mailing Address - Country:US
Mailing Address - Phone:908-552-4726
Mailing Address - Fax:
Practice Address - Street 1:3170 FM 407
Practice Address - Street 2:SUITE 405
Practice Address - City:HIGHLAND VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:75077-7049
Practice Address - Country:US
Practice Address - Phone:940-241-7172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier