Provider Demographics
NPI:1811379043
Name:TENERY OPTICAL, LLC
Entity Type:Organization
Organization Name:TENERY OPTICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEC/TRES
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WEBSTER
Authorized Official - Last Name:UPTON
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC
Authorized Official - Phone:972-566-8250
Mailing Address - Street 1:7777 FOREST LN
Mailing Address - Street 2:B424
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2571
Mailing Address - Country:US
Mailing Address - Phone:972-566-8250
Mailing Address - Fax:
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:B424
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2571
Practice Address - Country:US
Practice Address - Phone:972-566-8250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-24
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDR4071332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies