Provider Demographics
NPI:1427423771
Name:EYE KANDY LASHES BEAUTY BAR & BOUTIQUE
Entity type:Organization
Organization Name:EYE KANDY LASHES BEAUTY BAR & BOUTIQUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CORRINE
Authorized Official - Middle Name:SHARON
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:AMT, CO,
Authorized Official - Phone:770-865-3111
Mailing Address - Street 1:2365 POWDER SPRINGS RD SW
Mailing Address - Street 2:SUITE 1215
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-4567
Mailing Address - Country:US
Mailing Address - Phone:770-702-5663
Mailing Address - Fax:678-902-6833
Practice Address - Street 1:2365 POWDER SPRINGS RD SW
Practice Address - Street 2:SUITE 1215
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-4567
Practice Address - Country:US
Practice Address - Phone:770-702-5663
Practice Address - Fax:678-902-6833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACOSA051935302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization