Provider Demographics
NPI:1659054070
Name:OUTREACH EYECARE LLC
Entity Type:Organization
Organization Name:OUTREACH EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BOGDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRYNYK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:315-383-8617
Mailing Address - Street 1:1020 CARRINGTON PL FL 2
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1891
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1020 CARRINGTON PL FL 2
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1891
Practice Address - Country:US
Practice Address - Phone:813-534-8203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty