Provider Demographics
NPI:1033977715
Name:EAGLEVUE EYE CARE LLC
Entity Type:Organization
Organization Name:EAGLEVUE EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:Y-VAN
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:228-424-5142
Mailing Address - Street 1:6624 OAKBROOK DR
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-7913
Mailing Address - Country:US
Mailing Address - Phone:228-424-5142
Mailing Address - Fax:
Practice Address - Street 1:506 LARCHER BLVD BLDG 2306
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39534-2342
Practice Address - Country:US
Practice Address - Phone:228-432-8272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty