Provider Demographics
NPI:1891385282
Name:TOWER OPTICALS LLC
Entity Type:Organization
Organization Name:TOWER OPTICALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-365-0979
Mailing Address - Street 1:100 POPPY CT
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-7115
Mailing Address - Country:US
Mailing Address - Phone:561-275-2020
Mailing Address - Fax:561-828-8367
Practice Address - Street 1:1400 E WHITESTONE BLVD STE 400
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-9088
Practice Address - Country:US
Practice Address - Phone:561-275-2020
Practice Address - Fax:561-828-8367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-20
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear SupplierGroup - Single Specialty