Provider Demographics
NPI:1912626821
Name:EYEOWA WATERLOO LLC
Entity Type:Organization
Organization Name:EYEOWA WATERLOO LLC
Other - Org Name:MY EYELAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGED CARE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GARZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-275-2020
Mailing Address - Street 1:1523-1525 E. SAN MARNAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702
Mailing Address - Country:US
Mailing Address - Phone:956-335-6476
Mailing Address - Fax:561-828-8367
Practice Address - Street 1:1523 AND 1525 E. SAN MARNAN DR
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702
Practice Address - Country:US
Practice Address - Phone:956-335-6476
Practice Address - Fax:561-828-8367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-24
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear SupplierGroup - Single Specialty