Provider Demographics
NPI:1053495820
Name:LILLY EYE CARE, INC.
Entity Type:Organization
Organization Name:LILLY EYE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:BLAKE
Authorized Official - Last Name:LILLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-523-3937
Mailing Address - Street 1:2823 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25702-1423
Mailing Address - Country:US
Mailing Address - Phone:304-523-3937
Mailing Address - Fax:304-523-3945
Practice Address - Street 1:2823 3RD AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702-1423
Practice Address - Country:US
Practice Address - Phone:304-523-3937
Practice Address - Fax:304-523-3945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV17041261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty