Provider Demographics
NPI:1821474537
Name:EYENEZ INTEGRATED MANAGED EYE CARE NETWORK, A MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:EYENEZ INTEGRATED MANAGED EYE CARE NETWORK, A MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:B
Authorized Official - Last Name:KISLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-335-0535
Mailing Address - Street 1:210 S GRAND AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-4276
Mailing Address - Country:US
Mailing Address - Phone:626-335-0535
Mailing Address - Fax:626-963-0163
Practice Address - Street 1:210 S GRAND AVE STE 106
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-4276
Practice Address - Country:US
Practice Address - Phone:626-335-0535
Practice Address - Fax:626-963-0163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty