Provider Demographics
NPI:1659829505
Name:EYEDEOLOGY VISION CENTER LLC
Entity Type:Organization
Organization Name:EYEDEOLOGY VISION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DOBYNES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:314-518-3617
Mailing Address - Street 1:3629 N LINDBERGH BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT ANN
Mailing Address - State:MO
Mailing Address - Zip Code:63074-2106
Mailing Address - Country:US
Mailing Address - Phone:314-739-3937
Mailing Address - Fax:
Practice Address - Street 1:3629 N LINDBERGH BLVD
Practice Address - Street 2:
Practice Address - City:SAINT ANN
Practice Address - State:MO
Practice Address - Zip Code:63074-2106
Practice Address - Country:US
Practice Address - Phone:314-739-3937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier