Provider Demographics
NPI:1356758411
Name:EAGLE EYE CENTER
Entity type:Organization
Organization Name:EAGLE EYE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GALAYDH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-205-0107
Mailing Address - Street 1:PO BOX 7948
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00823-7948
Mailing Address - Country:US
Mailing Address - Phone:340-773-2393
Mailing Address - Fax:
Practice Address - Street 1:4100 SION FARM SHOPP CTR
Practice Address - Street 2:SUITE 1A
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820-4433
Practice Address - Country:US
Practice Address - Phone:340-773-2393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-21
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI1767207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273073100Medicaid
FL273073100Medicaid
FL16429ZMedicare PIN