Provider Demographics
NPI:1508495474
Name:EAGLE VIEW EYE CARE, LLC
Entity Type:Organization
Organization Name:EAGLE VIEW EYE CARE, LLC
Other - Org Name:LANIER EYE CARE, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:404-697-2850
Mailing Address - Street 1:4008 MUNDY MILL RD
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30566-2807
Mailing Address - Country:US
Mailing Address - Phone:706-576-7283
Mailing Address - Fax:706-640-3877
Practice Address - Street 1:4008 MUNDY MILL RD
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:GA
Practice Address - Zip Code:30566-2807
Practice Address - Country:US
Practice Address - Phone:706-576-7238
Practice Address - Fax:706-640-3877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-03
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty