Provider Demographics
NPI:1790852986
Name:EASTERN EYE ASSOCIATES, INC. OPTOMETRISTS
Entity Type:Organization
Organization Name:EASTERN EYE ASSOCIATES, INC. OPTOMETRISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:K
Authorized Official - Last Name:MEADOWS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:804-642-2290
Mailing Address - Street 1:3449 GEORGE WASHINGTON MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:HAYES
Mailing Address - State:VA
Mailing Address - Zip Code:23072-3100
Mailing Address - Country:US
Mailing Address - Phone:804-642-2290
Mailing Address - Fax:804-684-2166
Practice Address - Street 1:3449 GEORGE WASHINGTON MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:HAYES
Practice Address - State:VA
Practice Address - Zip Code:23072-3100
Practice Address - Country:US
Practice Address - Phone:804-642-2290
Practice Address - Fax:804-684-2166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4925650001Medicare NSC