Provider Demographics
NPI:1689455461
Name:TIDAL EYE CENTER LLC
Entity Type:Organization
Organization Name:TIDAL EYE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CRONAUER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:814-421-4641
Mailing Address - Street 1:4221 MAYFAIR ST
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5757
Mailing Address - Country:US
Mailing Address - Phone:843-448-6630
Mailing Address - Fax:843-448-5567
Practice Address - Street 1:4221 MAYFAIR ST
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5757
Practice Address - Country:US
Practice Address - Phone:843-448-6630
Practice Address - Fax:843-448-5567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-09
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty