Provider Demographics
NPI:1588068373
Name:EAGLE EYE CLINIC, PA
Entity type:Organization
Organization Name:EAGLE EYE CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GALAYDH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-365-7322
Mailing Address - Street 1:PO BOX 621736
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32762-1736
Mailing Address - Country:US
Mailing Address - Phone:407-365-7322
Mailing Address - Fax:
Practice Address - Street 1:2572 W STATE ROAD 426
Practice Address - Street 2:SUITE 3008
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-8389
Practice Address - Country:US
Practice Address - Phone:407-365-7322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-22
Last Update Date:2017-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty