Provider Demographics
NPI:1811179351
Name:BRIGHTEYES INC.
Entity type:Organization
Organization Name:BRIGHTEYES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:937-277-9991
Mailing Address - Street 1:5135 N DIXIE DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-3944
Mailing Address - Country:US
Mailing Address - Phone:937-277-9991
Mailing Address - Fax:
Practice Address - Street 1:5135 N DIXIE DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-3944
Practice Address - Country:US
Practice Address - Phone:937-277-9991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3912332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0711895Medicaid
OH0862281Medicare PIN
U12893Medicare UPIN
OH0683780001Medicare NSC