Provider Demographics
NPI:1871658609
Name:EYEGAZE INC.
Entity Type:Organization
Organization Name:EYEGAZE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DIXON
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEVELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-385-8800
Mailing Address - Street 1:10363 DEMOCRACY LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2505
Mailing Address - Country:US
Mailing Address - Phone:703-385-7133
Mailing Address - Fax:703-385-7137
Practice Address - Street 1:10363A DEMOCRACY LN
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030
Practice Address - Country:US
Practice Address - Phone:703-385-7133
Practice Address - Fax:703-385-7137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME17790000Medicaid
SCDM1330Medicaid
PA001953189-0001Medicaid
CA1871658609Medicaid
IN200345260AMedicaid
KY90006974Medicaid
VA9100598Medicaid
VA179619OtherANTHEM BLUE CROSS BLUE SHIELD
NM78723566Medicaid
NJ0185221Medicaid
VA1871658609Medicaid
MD4178963Medicaid
MIVLCT1986Medicaid
OH2411312Medicaid
WA9053661Medicaid
CT003113149Medicaid
AL009908055Medicaid
KY90006974Medicaid
MD4178963Medicaid
4489930001Medicare NSC