Provider Demographics
NPI:1609317858
Name:VOLUSIA EYE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:VOLUSIA EYE ASSOCIATES, LLC
Other - Org Name:VOLUSIA EYE OPTICAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OREST
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KRAJNYK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-424-1422
Mailing Address - Street 1:2568 S RIDGEWOOD AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:EDGEWATER
Mailing Address - State:FL
Mailing Address - Zip Code:32141-5980
Mailing Address - Country:US
Mailing Address - Phone:386-424-1422
Mailing Address - Fax:386-424-1401
Practice Address - Street 1:2568 S RIDGEWOOD AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:EDGEWATER
Practice Address - State:FL
Practice Address - Zip Code:32141-5980
Practice Address - Country:US
Practice Address - Phone:386-424-1422
Practice Address - Fax:386-424-1401
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VOLUSIA EYE ASSOCIATES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier