Provider Demographics
NPI:1710005137
Name:EYE PROS INC.
Entity Type:Organization
Organization Name:EYE PROS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:ROO
Authorized Official - Phone:209-669-9209
Mailing Address - Street 1:2803 GEER RD
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-1102
Mailing Address - Country:US
Mailing Address - Phone:209-669-9209
Mailing Address - Fax:209-634-1849
Practice Address - Street 1:2803 GEER RD
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-1102
Practice Address - Country:US
Practice Address - Phone:209-669-9209
Practice Address - Fax:209-634-1849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD6458332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4892810001Medicare ID - Type Unspecified