Provider Demographics
NPI:1154742427
Name:TIDAL FAMILY EYE CARE, LLC
Entity type:Organization
Organization Name:TIDAL FAMILY EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:K
Authorized Official - Last Name:OVERMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:757-249-0281
Mailing Address - Street 1:12300 JEFFERSON AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-6900
Mailing Address - Country:US
Mailing Address - Phone:757-249-0281
Mailing Address - Fax:
Practice Address - Street 1:12300 JEFFERSON AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-6900
Practice Address - Country:US
Practice Address - Phone:757-249-0281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002263152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty