Provider Demographics
NPI:1609400381
Name:IDEALEYES, O.D., PLLC
Entity Type:Organization
Organization Name:IDEALEYES, O.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:HARP
Authorized Official - Last Name:MCALLISTER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:336-777-1722
Mailing Address - Street 1:2596 REYNOLDA RD STE A
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-4651
Mailing Address - Country:US
Mailing Address - Phone:336-777-1722
Mailing Address - Fax:336-725-6954
Practice Address - Street 1:2596 REYNOLDA RD STE A
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-4651
Practice Address - Country:US
Practice Address - Phone:336-777-1722
Practice Address - Fax:336-725-6954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-02
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty