1952748360 NPI number — ROBERT H TEAGLE JR OPTOMETRIC CORP

Table of content: (NPI 1952748360)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952748360 NPI number — ROBERT H TEAGLE JR OPTOMETRIC CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT H TEAGLE JR OPTOMETRIC CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952748360
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27011 N MCBEAN PKWY
Provider Second Line Business Mailing Address:
107
Provider Business Mailing Address City Name:
VALENCIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91355
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-253-3888
Provider Business Mailing Address Fax Number:
661-253-4097

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27011 MCBEAN PKWY
Provider Second Line Business Practice Location Address:
107
Provider Business Practice Location Address City Name:
VALENCIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91355
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-253-3888
Provider Business Practice Location Address Fax Number:
661-253-4097
Provider Enumeration Date:
05/24/2013

Additional Information

Authorized Official

Authorized Official Last Name:
TEAGLE
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
H
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
661-253-3888

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  9104T , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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