Provider Demographics
NPI:1427318492
Name:MANILA EYEGLASS CENTER
Entity type:Organization
Organization Name:MANILA EYEGLASS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CECILLE
Authorized Official - Middle Name:POLICARPIO
Authorized Official - Last Name:NAVARRO RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC
Authorized Official - Phone:661-965-2551
Mailing Address - Street 1:8340 VAN NUYS BLVD. UNIT E
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402
Mailing Address - Country:US
Mailing Address - Phone:661-965-2551
Mailing Address - Fax:
Practice Address - Street 1:8340 VAN NUYS BLVD. UNIT E
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402
Practice Address - Country:US
Practice Address - Phone:661-965-2551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MANILA EYEGLASS CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
7577332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier