Provider Demographics
NPI:1922611342
Name:WISE EYES FAMILY EYE CARE, OD, PLLC
Entity Type:Organization
Organization Name:WISE EYES FAMILY EYE CARE, OD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:
Authorized Official - Last Name:TOTTEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:336-260-8586
Mailing Address - Street 1:631 COLISEUM DR STE 102
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-5310
Mailing Address - Country:US
Mailing Address - Phone:336-830-8061
Mailing Address - Fax:336-830-8162
Practice Address - Street 1:631 COLISEUM DR STE 102
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-5310
Practice Address - Country:US
Practice Address - Phone:336-830-8061
Practice Address - Fax:336-830-8162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-25
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty