Provider Demographics
NPI:1265220065
Name:EYEMAZING
Entity type:Organization
Organization Name:EYEMAZING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FUSSELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-992-4511
Mailing Address - Street 1:3824 THURSTON DR
Mailing Address - Street 2:
Mailing Address - City:MORGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84050-9906
Mailing Address - Country:US
Mailing Address - Phone:304-992-4511
Mailing Address - Fax:
Practice Address - Street 1:335 N 300 W STE 101
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-1815
Practice Address - Country:US
Practice Address - Phone:801-643-4277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty