Provider Demographics
NPI:1881778355
Name:EYE ASSOCIATES OF MIAMI, INC.
Entity type:Organization
Organization Name:EYE ASSOCIATES OF MIAMI, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WADE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-542-1929
Mailing Address - Street 1:2222 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354-1619
Mailing Address - Country:US
Mailing Address - Phone:918-542-1929
Mailing Address - Fax:918-542-7796
Practice Address - Street 1:2222 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-1619
Practice Address - Country:US
Practice Address - Phone:918-542-1929
Practice Address - Fax:918-542-7796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1202420001Medicare NSC