Provider Demographics
NPI:1487822201
Name:EYEZONE, INC.
Entity Type:Organization
Organization Name:EYEZONE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHITSCH
Authorized Official - Suffix:
Authorized Official - Credentials:OPTOMETRIST
Authorized Official - Phone:775-588-3500
Mailing Address - Street 1:PO BOX 7170
Mailing Address - Street 2:
Mailing Address - City:STATELINE
Mailing Address - State:NV
Mailing Address - Zip Code:89449-7170
Mailing Address - Country:US
Mailing Address - Phone:775-588-3500
Mailing Address - Fax:775-588-6045
Practice Address - Street 1:276 KINGSBURY GRADE
Practice Address - Street 2:SUITE 103
Practice Address - City:STATELINE
Practice Address - State:NV
Practice Address - Zip Code:89449-7170
Practice Address - Country:US
Practice Address - Phone:775-588-3500
Practice Address - Fax:775-588-6045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV278152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVAX561Medicare PIN
NV6097120001Medicare NSC