Provider Demographics
NPI:1659312452
Name:EYE PROS
Entity Type:Organization
Organization Name:EYE PROS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KREIDE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:912-965-9605
Mailing Address - Street 1:1370 US HIGHWAY 80 E
Mailing Address - Street 2:STE E
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-8902
Mailing Address - Country:US
Mailing Address - Phone:912-965-9605
Mailing Address - Fax:912-965-9604
Practice Address - Street 1:1370 US HIGHWAY 80 E
Practice Address - Street 2:STE E
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-8902
Practice Address - Country:US
Practice Address - Phone:912-965-9605
Practice Address - Fax:912-965-9604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT1194261Q00000X
GAOPT1194T332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7746Medicare PIN