Provider Demographics
NPI:1215292560
Name:EAGLE VISION
Entity type:Organization
Organization Name:EAGLE VISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:K
Authorized Official - Last Name:POWNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-886-2038
Mailing Address - Street 1:916 1/2 9TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-5224
Mailing Address - Country:US
Mailing Address - Phone:605-886-2038
Mailing Address - Fax:
Practice Address - Street 1:906 1/2 9TH AVE SE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201
Practice Address - Country:US
Practice Address - Phone:605-886-2038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier