Provider Demographics
NPI:1720793169
Name:EYES FOR KIDS AND TEENS
Entity Type:Organization
Organization Name:EYES FOR KIDS AND TEENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:REASONER
Authorized Official - Suffix:
Authorized Official - Credentials:RDO
Authorized Official - Phone:858-495-1488
Mailing Address - Street 1:7373 CLAIREMONT MESA BLVD STE 104B
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-1120
Mailing Address - Country:US
Mailing Address - Phone:858-495-1488
Mailing Address - Fax:858-495-1489
Practice Address - Street 1:7373 CLAIREMONT MESA BLVD STE 104B
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1120
Practice Address - Country:US
Practice Address - Phone:858-495-1488
Practice Address - Fax:858-495-1489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier