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General NPI Number Information
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NPI Number | 1033977715
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Entity Type | Organization
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Legal Business Name | EAGLEVUE EYE CARE LLC
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Dates
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Enumeration Date | 03/07/2024
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Last Update Date | 03/07/2024
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Provider Practice Location Address
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Address Line | 506 LARCHER BLVD BLDG 2306
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City | BILOXI
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State | MS
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Zip | 39534-2342
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Country | US
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Telephone | 228-432-8272
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Fax |
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Provider Business Mailing Address
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Address Line | 6624 OAKBROOK DR
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564-7913
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Country | US
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Telephone | 228-424-5142
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. KRISTY Y-VAN NGUYEN
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Credential | OD
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Telephone | 228-424-5142
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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