Organization
OPTICLUB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY LOUIS TEGENKAMP (PRESIDENT)
(850) 484-2807
Entity
Organization
Contact information
Practice address
6495 N DAVIS HWY, PENSACOLA, FL 32504-6954
(850) 484-2807
Mailing address
6495 N DAVIS HWY, PENSACOLA, FL 32504-6954
(850) 484-2807
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
DO3542
FL
Other
Enumeration date
05/07/2013
Last updated
05/07/2013
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