Provider Demographics
NPI:1033462965
Name:EAGLE EYE CARE
Entity Type:Organization
Organization Name:EAGLE EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN/ MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:HOOKS
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED OPTICIAN
Authorized Official - Phone:912-478-3937
Mailing Address - Street 1:98 GEORGIA AVE., BLDG 356
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458
Mailing Address - Country:US
Mailing Address - Phone:912-478-3937
Mailing Address - Fax:912-478-2537
Practice Address - Street 1:98 GEORGIA AVE., BLDG 356
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458
Practice Address - Country:US
Practice Address - Phone:912-478-3937
Practice Address - Fax:912-478-2537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001315152W00000X
GA001291156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty