Provider Demographics
NPI:1972746899
Name:EAGLE EYE IMAGING
Entity Type:Organization
Organization Name:EAGLE EYE IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:PASQUALE
Authorized Official - Last Name:IOELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-903-2781
Mailing Address - Street 1:10557 JUNIPER AVE UNIT E
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92337-7589
Mailing Address - Country:US
Mailing Address - Phone:909-356-4172
Mailing Address - Fax:
Practice Address - Street 1:10557 JUNIPER AVE UNIT E
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92337-7589
Practice Address - Country:US
Practice Address - Phone:909-356-4172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)