Provider Demographics
NPI:1093226383
Name:EYE INSTITUTE OD
Entity Type:Organization
Organization Name:EYE INSTITUTE OD
Other - Org Name:THE EYE INSTITUTE OD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUAVARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-266-2048
Mailing Address - Street 1:742 MCKNIGHT DR
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-7764
Mailing Address - Country:US
Mailing Address - Phone:919-266-2048
Mailing Address - Fax:919-266-4648
Practice Address - Street 1:111 SEABOARD AVE STE 110
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604
Practice Address - Country:US
Practice Address - Phone:919-200-4840
Practice Address - Fax:919-266-4648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-13
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty