Provider Demographics
NPI:1225560394
Name:SPRING CREEK EYECARE LLC
Entity Type:Organization
Organization Name:SPRING CREEK EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:RENAE
Authorized Official - Last Name:EASTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:434-260-0200
Mailing Address - Street 1:34 JEFFERSON CT
Mailing Address - Street 2:SUITE B
Mailing Address - City:ZION CROSSROADS
Mailing Address - State:VA
Mailing Address - Zip Code:22942-9602
Mailing Address - Country:US
Mailing Address - Phone:434-260-0220
Mailing Address - Fax:844-526-2650
Practice Address - Street 1:34 JEFFERSON CT
Practice Address - Street 2:SUITE B
Practice Address - City:ZION CROSSROADS
Practice Address - State:VA
Practice Address - Zip Code:22942-9602
Practice Address - Country:US
Practice Address - Phone:434-260-0220
Practice Address - Fax:844-526-2650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001497152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty