Provider Demographics
NPI:1992934301
Name:THE EYE GALLERY DC, LLC
Entity type:Organization
Organization Name:THE EYE GALLERY DC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-357-4799
Mailing Address - Street 1:700 PIER PARK DR
Mailing Address - Street 2:STE 110
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32413-2168
Mailing Address - Country:US
Mailing Address - Phone:850-387-4799
Mailing Address - Fax:850-230-8350
Practice Address - Street 1:700 PIER PARK DR
Practice Address - Street 2:STE 110
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32413-2168
Practice Address - Country:US
Practice Address - Phone:850-387-4799
Practice Address - Fax:850-230-8350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier