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General NPI Number Information
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NPI Number | 1679976310
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Entity Type | Organization
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Legal Business Name | TEG INC
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Dates
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Enumeration Date | 10/08/2014
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Last Update Date | 10/08/2014
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Provider Practice Location Address
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Address Line | 700 PIER PARK DR
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32413-2168
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Country | US
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Telephone | 850-230-8350
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Fax | 850-230-8340
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Provider Business Mailing Address
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Address Line | 520 8TH AVE 23 FLOOR
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City | NEW YORK
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State | NY
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Zip | 10018-6507
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Country | US
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Telephone | 212-792-8149
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Fax | 646-448-3327
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | LAURA VALENTIN
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Credential |
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Telephone | 212-792-8149
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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