Provider Demographics
NPI:1972615003
Name:EYEDEAL, INC.
Entity Type:Organization
Organization Name:EYEDEAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:BREAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-825-4857
Mailing Address - Street 1:633 SUNSET LN STE D
Mailing Address - Street 2:
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-3942
Mailing Address - Country:US
Mailing Address - Phone:540-825-4857
Mailing Address - Fax:540-825-9431
Practice Address - Street 1:633 SUNSET LN STE D
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3942
Practice Address - Country:US
Practice Address - Phone:540-825-4857
Practice Address - Fax:540-825-9431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0277590001332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0277590001Medicare NSC