Provider Demographics
NPI:1154458602
Name:EYESIGHT OPTOMETRISTS PC
Entity Type:Organization
Organization Name:EYESIGHT OPTOMETRISTS PC
Other - Org Name:INSIGHT OPTOMETRIST PEARLE VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:D
Authorized Official - Last Name:D'ANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:757-424-0724
Mailing Address - Street 1:1412 GREENBRIER PKWY
Mailing Address - Street 2:SUITE 108A
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2832
Mailing Address - Country:US
Mailing Address - Phone:757-424-6095
Mailing Address - Fax:757-424-4349
Practice Address - Street 1:1412 GREENBRIER PKWY
Practice Address - Street 2:SUITE 108A
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2832
Practice Address - Country:US
Practice Address - Phone:757-424-6095
Practice Address - Fax:757-424-4349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4709050001Medicare NSC