Provider Demographics
NPI:1558539585
Name:EYEDEALS OPTOMETRY PA
Entity Type:Organization
Organization Name:EYEDEALS OPTOMETRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-877-9300
Mailing Address - Street 1:4905 GREEN ROAD
Mailing Address - Street 2:SUITE 107B
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616
Mailing Address - Country:US
Mailing Address - Phone:919-877-9300
Mailing Address - Fax:
Practice Address - Street 1:4905 GREEN RD
Practice Address - Street 2:SUITE 107B
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-2805
Practice Address - Country:US
Practice Address - Phone:919-877-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty