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General NPI Number Information
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NPI Number | 1659312452
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Entity Type | Organization
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Legal Business Name | EYE PROS
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 03/19/2008
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Provider Practice Location Address
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Address Line | 1370 US HIGHWAY 80 E STE E
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City | POOLER
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State | GA
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Zip | 31322-8902
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Country | US
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Telephone | 912-965-9605
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Fax | 912-965-9604
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Provider Business Mailing Address
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Address Line | 1370 US HIGHWAY 80 E STE E
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City | POOLER
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State | GA
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Zip | 31322-8902
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Country | US
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Telephone | 912-965-9605
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Fax | 912-965-9604
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHRISTINE A KREIDE
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Credential | O.D.
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Telephone | 912-965-9605
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | OPT1194T
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | OPT1194
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License Number State | GA
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