Provider Demographics
NPI:1669557948
Name:EYETECH VISIONCARE, LTD
Entity type:Organization
Organization Name:EYETECH VISIONCARE, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DON
Authorized Official - Middle Name:D
Authorized Official - Last Name:STATEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:775-353-5665
Mailing Address - Street 1:1261 BARING BLVD
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-8673
Mailing Address - Country:US
Mailing Address - Phone:775-353-5665
Mailing Address - Fax:775-353-5660
Practice Address - Street 1:1261 BARING BLVD
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-8673
Practice Address - Country:US
Practice Address - Phone:775-353-5665
Practice Address - Fax:775-353-5660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVDD5573OtherRAILROAD MEDICARE
NV0195990002Medicare NSC
NVDD5573OtherRAILROAD MEDICARE