Provider Demographics
NPI:1316662802
Name:ZOEYE BEACH SUNS, LLLP
Entity type:Organization
Organization Name:ZOEYE BEACH SUNS, LLLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARNA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED OPTICIAN
Authorized Official - Phone:540-315-5015
Mailing Address - Street 1:7629 WILLIAMSON RD STE 14
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-4371
Mailing Address - Country:US
Mailing Address - Phone:540-315-5015
Mailing Address - Fax:
Practice Address - Street 1:1450 W CORBETT AVE STE 3
Practice Address - Street 2:
Practice Address - City:SWANSBORO
Practice Address - State:NC
Practice Address - Zip Code:28584-9036
Practice Address - Country:US
Practice Address - Phone:910-325-8388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1336888775Medicaid
NC1669027603Medicaid