Provider Demographics
NPI:1730484361
Name:GOLD EAGLE OPTICS
Entity Type:Organization
Organization Name:GOLD EAGLE OPTICS
Other - Org Name:EYE VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:228-872-1170
Mailing Address - Street 1:6616 WASHINGTON AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-2180
Mailing Address - Country:US
Mailing Address - Phone:228-872-1170
Mailing Address - Fax:
Practice Address - Street 1:6616 WASHINGTON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-2180
Practice Address - Country:US
Practice Address - Phone:228-872-1170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS024-30565-8332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier