Provider Demographics
NPI:1316186737
Name:EYE CLINIC,LLC
Entity type:Organization
Organization Name:EYE CLINIC,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIDANE
Authorized Official - Middle Name:H
Authorized Official - Last Name:ASSEFA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:340-774-1531
Mailing Address - Street 1:PO BOX 302682
Mailing Address - Street 2:
Mailing Address - City:ST. THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00803
Mailing Address - Country:US
Mailing Address - Phone:340-774-1531
Mailing Address - Fax:340-774-1517
Practice Address - Street 1:9151 ESTATE THOMAS
Practice Address - Street 2:FOOTHILLS PROFESSIONAL BLD#107
Practice Address - City:ST. THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802
Practice Address - Country:US
Practice Address - Phone:340-774-1531
Practice Address - Fax:340-774-1517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-09
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VIVI1290261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI1720185184OtherNPI