Provider Demographics
NPI:1801518329
Name:HARVEST EYE CARELLC
Entity type:Organization
Organization Name:HARVEST EYE CARELLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BULLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:509-554-1521
Mailing Address - Street 1:119 BURWELL RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:HARVEST
Mailing Address - State:AL
Mailing Address - Zip Code:35749-9644
Mailing Address - Country:US
Mailing Address - Phone:509-554-1021
Mailing Address - Fax:
Practice Address - Street 1:5850 HIGHWAY 53 STE J
Practice Address - Street 2:
Practice Address - City:HARVEST
Practice Address - State:AL
Practice Address - Zip Code:35749-4302
Practice Address - Country:US
Practice Address - Phone:509-554-1021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-12
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty