Provider Demographics
NPI:1558769984
Name:THE EYE GUY BUSINESS HOLDINGS INC
Entity Type:Organization
Organization Name:THE EYE GUY BUSINESS HOLDINGS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:TEGENKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:FL DO830
Authorized Official - Phone:850-434-6387
Mailing Address - Street 1:5328 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2006
Mailing Address - Country:US
Mailing Address - Phone:850-434-6387
Mailing Address - Fax:850-432-0540
Practice Address - Street 1:5328 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2006
Practice Address - Country:US
Practice Address - Phone:850-434-6387
Practice Address - Fax:850-432-0540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-17
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO 830332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier