Organization
EYEGLASS SHOPP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT JOSEPH BAILEN ABOC (MEMBER/OPTICIAN)
(715) 682-8181
Entity
Organization
Contact information
Practice address
200 MAIN ST W, ASHLAND, WI 54806-1606
(715) 682-8181
(715) 682-8181
Mailing address
200 MAIN ST W, ASHLAND, WI 54806-1606
(715) 682-8181
(715) 682-8181
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100085010
—
WI
Enumeration date
04/23/2019
Last updated
04/23/2019
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