Provider Demographics
NPI:1831747336
Name:EYE SMILE OPTOMETRY PLLC
Entity type:Organization
Organization Name:EYE SMILE OPTOMETRY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:585-857-0891
Mailing Address - Street 1:4231 COLUMBIA PIKE STE 102
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-1876
Mailing Address - Country:US
Mailing Address - Phone:571-441-0041
Mailing Address - Fax:
Practice Address - Street 1:4231 COLUMBIA PIKE
Practice Address - Street 2:SUITE 102
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-3017
Practice Address - Country:US
Practice Address - Phone:571-441-0041
Practice Address - Fax:571-441-0045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-28
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty