Provider Demographics
NPI:1497360564
Name:SEASCAPE EYECARE ASSOCIATES LLC
Entity Type:Organization
Organization Name:SEASCAPE EYECARE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OSVALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-937-2107
Mailing Address - Street 1:4240 PORTSMOUTH BLVD STE 237
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-2129
Mailing Address - Country:US
Mailing Address - Phone:954-937-2107
Mailing Address - Fax:
Practice Address - Street 1:2444 CHESAPEAKE SQUARE RING RD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-2173
Practice Address - Country:US
Practice Address - Phone:954-937-2107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty