Provider Demographics
NPI:1104005891
Name:EYESITE LTD
Entity Type:Organization
Organization Name:EYESITE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:F
Authorized Official - Last Name:HAMM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:505-397-3611
Mailing Address - Street 1:201 W FOX ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-5736
Mailing Address - Country:US
Mailing Address - Phone:505-234-9526
Mailing Address - Fax:
Practice Address - Street 1:201 W FOX ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-5736
Practice Address - Country:US
Practice Address - Phone:505-234-9526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM2223152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty