Provider Demographics
NPI:1417446006
Name:EAGLES EYE LAB, INC
Entity Type:Organization
Organization Name:EAGLES EYE LAB, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARLEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-333-1568
Mailing Address - Street 1:4501 NEW BERN AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1550
Mailing Address - Country:US
Mailing Address - Phone:919-333-1568
Mailing Address - Fax:
Practice Address - Street 1:4501 NEW BERN AVE, STE: 130
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610
Practice Address - Country:US
Practice Address - Phone:919-333-1568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory