Provider Demographics
NPI:1952865172
Name:007 EYES, LLC
Entity Type:Organization
Organization Name:007 EYES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRESLYN
Authorized Official - Middle Name:BARON
Authorized Official - Last Name:ODUM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:912-380-8007
Mailing Address - Street 1:420 W CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31545-1435
Mailing Address - Country:US
Mailing Address - Phone:912-380-8007
Mailing Address - Fax:912-380-8007
Practice Address - Street 1:420 W CHERRY ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-1435
Practice Address - Country:US
Practice Address - Phone:912-380-8007
Practice Address - Fax:912-380-8007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center