Provider Demographics
NPI:1780067892
Name:MANILA EYEGLASS CENTER INC
Entity type:Organization
Organization Name:MANILA EYEGLASS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CECILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:NAVARRO RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC
Authorized Official - Phone:818-433-1475
Mailing Address - Street 1:8340 VAN NUYS BLVD UNIT E
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-3760
Mailing Address - Country:US
Mailing Address - Phone:818-433-1475
Mailing Address - Fax:818-830-5682
Practice Address - Street 1:8340 VAN NUYS BLVD UNIT E
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-3760
Practice Address - Country:US
Practice Address - Phone:818-433-1475
Practice Address - Fax:818-830-5682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD70608332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier