Provider Demographics
NPI:1104113554
Name:EYE DEAL OPTICAL, LLC.
Entity type:Organization
Organization Name:EYE DEAL OPTICAL, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-788-2325
Mailing Address - Street 1:5125 HIGHWAY 278 NW
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-2123
Mailing Address - Country:US
Mailing Address - Phone:770-788-2325
Mailing Address - Fax:770-788-2327
Practice Address - Street 1:5125 HIGHWAY 278 NW
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2123
Practice Address - Country:US
Practice Address - Phone:770-788-2325
Practice Address - Fax:770-788-2327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier