Provider Demographics
NPI:1447496427
Name:EAGLE EYE VISION SERVICES
Entity type:Organization
Organization Name:EAGLE EYE VISION SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:LAVERN
Authorized Official - Last Name:CLAPPER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:208-676-7356
Mailing Address - Street 1:PO BOX 2592
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835
Mailing Address - Country:US
Mailing Address - Phone:208-676-7356
Mailing Address - Fax:208-676-7384
Practice Address - Street 1:355 E. NEIDER AVENUE
Practice Address - Street 2:
Practice Address - City:COEUR D'ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815
Practice Address - Country:US
Practice Address - Phone:208-676-7356
Practice Address - Fax:207-676-7384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-23
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty