Provider Demographics
NPI:1073712147
Name:EGGER OPTICAL
Entity Type:Organization
Organization Name:EGGER OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICAL ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BOOZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-332-3400
Mailing Address - Street 1:505 ARNOLD AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-5320
Mailing Address - Country:US
Mailing Address - Phone:662-332-3400
Mailing Address - Fax:662-332-3402
Practice Address - Street 1:505 ARNOLD AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-5320
Practice Address - Country:US
Practice Address - Phone:662-332-3400
Practice Address - Fax:662-332-3402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier