Provider Demographics
NPI:1013143411
Name:EAGLE EYE DME LLC
Entity Type:Organization
Organization Name:EAGLE EYE DME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:TESS
Authorized Official - Last Name:GURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-665-1905
Mailing Address - Street 1:180 STROBBE LANE
Mailing Address - Street 2:
Mailing Address - City:COUNCE
Mailing Address - State:TN
Mailing Address - Zip Code:38326
Mailing Address - Country:US
Mailing Address - Phone:662-665-1905
Mailing Address - Fax:
Practice Address - Street 1:11240 HWY 57
Practice Address - Street 2:
Practice Address - City:COUNCE
Practice Address - State:TN
Practice Address - Zip Code:38326
Practice Address - Country:US
Practice Address - Phone:662-665-1905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6286890001Medicare NSC