Provider Demographics
NPI:1295917714
Name:EYEDEAS UNLIMITED INC
Entity type:Organization
Organization Name:EYEDEAS UNLIMITED INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED OPTICIAN/ VP
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:WHITE
Authorized Official - Last Name:MAYNARD
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:828-256-6620
Mailing Address - Street 1:1706 US HIGHWAY 70 SE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-5154
Mailing Address - Country:US
Mailing Address - Phone:828-326-9144
Mailing Address - Fax:828-326-9292
Practice Address - Street 1:1706 US HIGHWAY 70 SE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-5154
Practice Address - Country:US
Practice Address - Phone:828-326-9144
Practice Address - Fax:828-326-9292
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYEDEAS UNLIMITED INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC581332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier