Provider Demographics
NPI:1922559491
Name:THE EYE TEAM, PC
Entity Type:Organization
Organization Name:THE EYE TEAM, PC
Other - Org Name:THE EYE TEAM ALBANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:541-926-2061
Mailing Address - Street 1:1037 8TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-2053
Mailing Address - Country:US
Mailing Address - Phone:541-926-2061
Mailing Address - Fax:541-926-4845
Practice Address - Street 1:2169 14TH AVE SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97322-8510
Practice Address - Country:US
Practice Address - Phone:541-926-2061
Practice Address - Fax:541-926-4845
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE EYE TEAM, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2733ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty