Provider Demographics
NPI:1013571850
Name:MGB EYES, INC.
Entity Type:Organization
Organization Name:MGB EYES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-839-2233
Mailing Address - Street 1:350 SEABOARD ST
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-9627
Mailing Address - Country:US
Mailing Address - Phone:843-839-2233
Mailing Address - Fax:843-839-0137
Practice Address - Street 1:350 SEABOARD ST
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-9627
Practice Address - Country:US
Practice Address - Phone:843-839-2233
Practice Address - Fax:843-839-0137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty