Provider Demographics
NPI:1689030405
Name:EYE CARE 108, LLC
Entity Type:Organization
Organization Name:EYE CARE 108, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DYLAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:BELT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:757-562-4321
Mailing Address - Street 1:108 W 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:VA
Mailing Address - Zip Code:23851-1712
Mailing Address - Country:US
Mailing Address - Phone:757-562-4321
Mailing Address - Fax:757-562-3378
Practice Address - Street 1:108 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:VA
Practice Address - Zip Code:23851-1712
Practice Address - Country:US
Practice Address - Phone:757-562-4321
Practice Address - Fax:757-562-3378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-08
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001815152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty