Provider Demographics
NPI:1831310788
Name:EYELAND OPTICAL INC
Entity type:Organization
Organization Name:EYELAND OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WAINWRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:850-215-3937
Mailing Address - Street 1:851 E 23RD ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-5311
Mailing Address - Country:US
Mailing Address - Phone:850-215-3937
Mailing Address - Fax:850-215-7337
Practice Address - Street 1:851 E 23RD ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-5311
Practice Address - Country:US
Practice Address - Phone:850-215-3937
Practice Address - Fax:850-215-3937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty