Organization
EYETIQUE CORPORATION
Active
Other names
3 Guys Optical
Organization subpart
No
Provider details
NPI number
Authorized official
CATHY L SHORT (CREDENTIALING MANAGER)
(618) 462-9818
Entity
Organization
Contact information
Practice address
535 ADAMS SHOPPES, MARS, PA 16046-3968
(724) 591-8515
(724) 591-8517
Mailing address
211 E BROADWAY, ALTON, IL 62002-6220
(618) 462-9818
(314) 741-4947
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
PA
Enumeration date
05/01/2018
Last updated
06/27/2018
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