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General NPI Number Information
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NPI Number | 1295917714
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Entity Type | Organization
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Legal Business Name | EYEDEAS UNLIMITED INC
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Dates
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Enumeration Date | 11/27/2007
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Last Update Date | 11/27/2007
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Provider Practice Location Address
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Address Line | 1706 US HIGHWAY 70 SE
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City | HICKORY
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State | NC
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Zip | 28602-5154
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Country | US
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Telephone | 828-326-9144
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Fax | 828-326-9292
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Provider Business Mailing Address
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Address Line | 1706 US HIGHWAY 70 SE
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City | HICKORY
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State | NC
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Zip | 28602-5154
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Country | US
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Telephone | 828-326-9144
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Fax | 828-326-9292
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Authorized Official
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Title or Position | LICENSED OPTICIAN/ VP
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Name | MRS. DIANE WHITE MAYNARD
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Credential | OPTICIAN
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Telephone | 828-256-6620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 581
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License Number State | NC
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