| Organization Name: | CUSTOM EYES RX INC |
| NPI Number: | 1982732715 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JEFFREY TODD LIEGNER (MEDICAL DIRECTOR) |
| Mailing Address: | 111 Hulst Dr Ste 706 Kmart Westfall Shopping Center Matamoras |
| State: | PA US |
| Postal Code: | 183362115 |
| Phone Number: | 5704915454 |
| Fax Number: | 5704912895 |
| NPI Enumeration Date: | 03/01/2007 |
| NPI Last Update Date: | 06/23/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QH0100X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | |