Provider Demographics
NPI:1225245772
Name:CIVILEYES LLC
Entity Type:Organization
Organization Name:CIVILEYES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC
Authorized Official - Phone:707-766-7000
Mailing Address - Street 1:119 C ST
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-3069
Mailing Address - Country:US
Mailing Address - Phone:707-766-7000
Mailing Address - Fax:
Practice Address - Street 1:119 C ST
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-3069
Practice Address - Country:US
Practice Address - Phone:707-766-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD7168156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty