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General NPI Number Information
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NPI Number | 1912626821
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Entity Type | Organization
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Legal Business Name | EYEOWA WATERLOO LLC
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Dates
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Enumeration Date | 08/24/2022
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Last Update Date | 09/01/2022
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Provider Practice Location Address
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Address Line | 1523 AND 1525 E. SAN MARNAN DR
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City | WATERLOO
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State | IA
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Zip | 50702
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Country | US
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Telephone | 956-335-6476
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Fax | 561-828-8367
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Provider Business Mailing Address
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Address Line | 1523-1525 E. SAN MARNAN DRIVE
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City | WATERLOO
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State | IA
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Zip | 50702
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Country | US
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Telephone | 956-335-6476
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Fax | 561-828-8367
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Authorized Official
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Title or Position | MANAGED CARE MANAGER
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Name | DANIEL GARZA
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Credential |
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Telephone | 561-275-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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