Provider Demographics
NPI:1235672858
Name:INTERNATIONAL EYE FOUNDATION
Entity Type:Organization
Organization Name:INTERNATIONAL EYE FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SELVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GNANAKKAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:602-770-9300
Mailing Address - Street 1:1135 REGINA DR
Mailing Address - Street 2:
Mailing Address - City:HALETHORPE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-2342
Mailing Address - Country:US
Mailing Address - Phone:602-770-9300
Mailing Address - Fax:602-535-3165
Practice Address - Street 1:4000 OLD COURT RD
Practice Address - Street 2:SUITE 204
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-2800
Practice Address - Country:US
Practice Address - Phone:410-653-2400
Practice Address - Fax:602-535-3165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty