Provider Demographics
NPI:1487823589
Name:EYETECH VISIONCARE, LTD.
Entity Type:Organization
Organization Name:EYETECH VISIONCARE, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DON
Authorized Official - Middle Name:D
Authorized Official - Last Name:STATEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:775-353-5665
Mailing Address - Street 1:1261 BARING BLVD
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-8673
Mailing Address - Country:US
Mailing Address - Phone:775-353-5665
Mailing Address - Fax:775-353-5660
Practice Address - Street 1:3915 BAKER LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-5544
Practice Address - Country:US
Practice Address - Phone:775-825-3232
Practice Address - Fax:775-689-2494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV168152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVDD5573OtherRAILROAD MEDICARE
NV0195990003Medicare NSC
NVWCHCZMedicare PIN