Provider Demographics
NPI:1962112888
Name:EYEWEAR UNLIMITED INC
Entity type:Organization
Organization Name:EYEWEAR UNLIMITED INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:757-588-0020
Mailing Address - Street 1:1881 E LITTLE CREEK RD # 2
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23518-4222
Mailing Address - Country:US
Mailing Address - Phone:757-588-0020
Mailing Address - Fax:757-588-0020
Practice Address - Street 1:1881 E LITTLE CREEK RD # 2
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23518-4222
Practice Address - Country:US
Practice Address - Phone:757-588-0020
Practice Address - Fax:757-588-0020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA30016061890002Medicaid