Provider Demographics
NPI:1679031413
Name:WEST SIDE EYE SPECS LLC
Entity Type:Organization
Organization Name:WEST SIDE EYE SPECS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HYDE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:212-877-2980
Mailing Address - Street 1:2165 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6603
Mailing Address - Country:US
Mailing Address - Phone:212-877-2980
Mailing Address - Fax:
Practice Address - Street 1:2165 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6603
Practice Address - Country:US
Practice Address - Phone:212-877-2980
Practice Address - Fax:212-877-0549
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST SIDE EYE SPECS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty