Provider Demographics
NPI:1881224681
Name:SIDE EYE LLC
Entity Type:Organization
Organization Name:SIDE EYE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:S
Authorized Official - Last Name:BARR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:404-310-1593
Mailing Address - Street 1:106 OAKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-3626
Mailing Address - Country:US
Mailing Address - Phone:770-833-3589
Mailing Address - Fax:
Practice Address - Street 1:47 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-1948
Practice Address - Country:US
Practice Address - Phone:770-254-0200
Practice Address - Fax:770-254-1281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-21
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty