Provider Demographics
NPI: | 1760859771 |
---|---|
Name: | EVERCLEAR EYES, P.C. |
Entity Type: | Organization |
Organization Name: | EVERCLEAR EYES, P.C. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | DARA |
Authorized Official - Middle Name: | ELIZABETH |
Authorized Official - Last Name: | BARBASH |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | OD |
Authorized Official - Phone: | 407-620-2067 |
Mailing Address - Street 1: | 1837 GARNER LN |
Mailing Address - Street 2: | |
Mailing Address - City: | VIRGINIA BEACH |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 23464-1698 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 407-620-2067 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 701 LYNNHAVEN PKWY |
Practice Address - Street 2: | F85 |
Practice Address - City: | VIRGINIA BEACH |
Practice Address - State: | VA |
Practice Address - Zip Code: | 23452-7299 |
Practice Address - Country: | US |
Practice Address - Phone: | 757-340-3853 |
Practice Address - Fax: | 757-340-3854 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-08-25 |
Last Update Date: | 2015-08-25 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
VA | 0618001610 | 152W00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 152W00000X | Eye and Vision Services Providers | Optometrist | Group - Multi-Specialty |