Provider Demographics
NPI:1891061248
Name:EYE SITE, INC.
Entity Type:Organization
Organization Name:EYE SITE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:MAUND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:256-232-4747
Mailing Address - Street 1:725 W. MARKET ST.
Mailing Address - Street 2:STE. A
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-2456
Mailing Address - Country:US
Mailing Address - Phone:256-232-4747
Mailing Address - Fax:256-232-4807
Practice Address - Street 1:725 W MARKET ST
Practice Address - Street 2:STE. A
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-2456
Practice Address - Country:US
Practice Address - Phone:256-232-4747
Practice Address - Fax:256-232-4807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS738TA149152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty