Provider Demographics
NPI:1972805406
Name:MOBILE EYEWORKS LLC
Entity type:Organization
Organization Name:MOBILE EYEWORKS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:CREIGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:360-510-4432
Mailing Address - Street 1:605 WOOD CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LYNDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98264-1107
Mailing Address - Country:US
Mailing Address - Phone:360-510-4432
Mailing Address - Fax:360-318-0821
Practice Address - Street 1:605 WOOD CREEK DR
Practice Address - Street 2:
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-1107
Practice Address - Country:US
Practice Address - Phone:360-510-4432
Practice Address - Fax:360-318-0821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-05
Last Update Date:2010-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602953802332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier