Provider Demographics
NPI:1124515234
Name:EYE LOGIC LLC
Entity type:Organization
Organization Name:EYE LOGIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:W
Authorized Official - Last Name:GUARINO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:603-742-0045
Mailing Address - Street 1:347 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-3630
Mailing Address - Country:US
Mailing Address - Phone:603-343-5511
Mailing Address - Fax:
Practice Address - Street 1:158A NH ROUTE 108
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-8812
Practice Address - Country:US
Practice Address - Phone:603-742-0045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH0706152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty