Provider Demographics
NPI:1033346036
Name:CAPITAL EYES LLC
Entity Type:Organization
Organization Name:CAPITAL EYES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:DUVENDACK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:419-346-3216
Mailing Address - Street 1:7131 OLD MILL RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-3023
Mailing Address - Country:US
Mailing Address - Phone:419-867-0544
Mailing Address - Fax:419-867-0604
Practice Address - Street 1:1355 S MCCORD RD
Practice Address - Street 2:VISION CENTER
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-9141
Practice Address - Country:US
Practice Address - Phone:419-867-0544
Practice Address - Fax:419-867-0604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5026152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty