Organization
EYE CLINIC,LLC
Active
Organization
EYE CLINIC,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KIDANE H ASSEFA MD (OWNER)
(340) 774-1531
Entity
Organization
Contact information
Practice address
9151 ESTATE THOMAS, FOOTHILLS PROFESSIONAL BLD#107, ST. THOMAS, VI 00802
(340) 774-1531
(340) 774-1517
Mailing address
PO BOX 302682, ST. THOMAS, VI 00803
(340) 774-1531
(340) 774-1517
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
VI1290
VI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1720185184
NPI
VI
Enumeration date
02/09/2009
Last updated
12/06/2012
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