MEDICARE: TEG INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1336544352
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEG INC.

Provider Business Mailing Address
First Line	:	520 8TH AVE
Second Line	:	23RD FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10018-6507
Country	:	US
Telephone Number	:	212-792-8149
Fax Number	:	646-448-3327

Provider Business Practice Location Address
First Line	:	3330 PIEDMONT RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30305-1726
Country	:	US
Telephone Number	:	404-231-3772
Fax Number	:	404-264-0779

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	LAURA V VALENTIN
Credential	:
Telephone Number	:	212-792-8149

Provider Enumeration Date	:	11/03/2014
Last Update Date	:	11/03/2014

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