Provider Demographics
NPI:1639360407
Name:EYE TO EYE INC
Entity Type:Organization
Organization Name:EYE TO EYE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:J
Authorized Official - Last Name:QUISPE-FLEET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-253-0084
Mailing Address - Street 1:13061 WISTERIA DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-2621
Mailing Address - Country:US
Mailing Address - Phone:301-253-0084
Mailing Address - Fax:240-207-3271
Practice Address - Street 1:13061 WISTERIA DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-2621
Practice Address - Country:US
Practice Address - Phone:301-253-0084
Practice Address - Fax:240-207-3271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA0879152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD207948Medicare PIN