Provider Demographics
NPI:1275735870
Name:EYE DESIGNS OPTICAL
Entity Type:Organization
Organization Name:EYE DESIGNS OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MERRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-342-6664
Mailing Address - Street 1:1227 MAPLE AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-4707
Mailing Address - Country:US
Mailing Address - Phone:540-342-6664
Mailing Address - Fax:540-342-7063
Practice Address - Street 1:1227 MAPLE AVE SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4707
Practice Address - Country:US
Practice Address - Phone:540-342-6664
Practice Address - Fax:540-342-7063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA106442332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA3922660001Medicare ID - Type UnspecifiedSUPPLIER PIN