Provider Demographics
NPI:1609514637
Name:EYE 2 EYE OPTICAL
Entity Type:Organization
Organization Name:EYE 2 EYE OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:GRANT
Authorized Official - Last Name:GAUSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:ABO OPTICIAN
Authorized Official - Phone:218-998-3937
Mailing Address - Street 1:210 N CASCADE ST
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-2253
Mailing Address - Country:US
Mailing Address - Phone:218-998-3937
Mailing Address - Fax:218-998-3938
Practice Address - Street 1:210 N CASCADE ST
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-2253
Practice Address - Country:US
Practice Address - Phone:218-998-3937
Practice Address - Fax:218-998-3938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-20
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier