Provider Demographics
NPI:1144415274
Name:EYEDEAS UNLIMITED INC
Entity Type:Organization
Organization Name:EYEDEAS UNLIMITED INC
Other - Org Name:LOOKING GLASS VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:WHITE
Authorized Official - Last Name:MAYNARD
Authorized Official - Suffix:
Authorized Official - Credentials:NC LICENSED OPTICIAN
Authorized Official - Phone:828-256-6620
Mailing Address - Street 1:2571 SPRINGS RD NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-3169
Mailing Address - Country:US
Mailing Address - Phone:828-256-6620
Mailing Address - Fax:828-256-4970
Practice Address - Street 1:2571 SPRINGS RD NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-3169
Practice Address - Country:US
Practice Address - Phone:828-256-6620
Practice Address - Fax:828-256-4970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC581332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1005020001Medicare NSC