NPIMap

Organization Active NPI

Opticlub

  • Eyewear Supplier
  • Pensacola, FL
National Provider Identifier
1740625417
Registry record updated May 7, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
License
DO3542 Issued in FL
Legal business name
OPTICLUB
Practice address
6495 N Davis Hwy
Pensacola, FL 32504-6954
Phone
(850) 484-2807
NPI assigned
May 7, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Jeffrey Louis TegenkampNPI 1366999104
Title
President
Phone
(850) 484-2807

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X DO3542 FL Primary

Addresses

Primary practice location

6495 N Davis Hwy
Pensacola, FL 32504-6954

Mailing address

6495 N Davis Hwy
Pensacola, FL 32504-6954
Phone (850) 484-2807

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1367884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367884800000",
    "number": "1740625417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6495 N DAVIS HWY",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325046954",
            "telephone_number": "850-484-2807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6495 N DAVIS HWY",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325046954",
            "telephone_number": "850-484-2807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTICLUB",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-07",
        "last_updated": "2013-05-07",
        "status": "A",
        "authorized_official_last_name": "TEGENKAMP",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "LOUIS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "850-484-2807",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "FL",
            "license": "DO3542",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pensacola, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.