Provider Demographics
NPI:1538784327
Name:SASSY EYES BOUTIQUE, LLC
Entity type:Organization
Organization Name:SASSY EYES BOUTIQUE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DWAYNE
Authorized Official - Last Name:MULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:248-777-1414
Mailing Address - Street 1:28911 7 MILE RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-3503
Mailing Address - Country:US
Mailing Address - Phone:248-777-1414
Mailing Address - Fax:
Practice Address - Street 1:28911 7 MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3503
Practice Address - Country:US
Practice Address - Phone:248-777-1414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier