Provider Demographics
NPI:1710333075
Name:EGMA LLC
Entity Type:Organization
Organization Name:EGMA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VP
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:HARRIS
Authorized Official - Last Name:YUSTRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-488-3462
Mailing Address - Street 1:11234 GOODNIGHT LANE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-7807
Mailing Address - Country:US
Mailing Address - Phone:972-488-3462
Mailing Address - Fax:214-238-0620
Practice Address - Street 1:11234 GOODNIGHT LANE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75229
Practice Address - Country:US
Practice Address - Phone:972-488-3462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier