1013058361 NPI number — NUVUE OPTICAL, PLLC

Table of content: (NPI 1013058361)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013058361 NPI number — NUVUE OPTICAL, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NUVUE OPTICAL, PLLC
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:
NUVUE EYECARE
Provider Other Organization Name Type Code:
3
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:
1013058361
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6601 SUGAR VALLEY DR
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37211-7091
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-419-3331
Provider Business Mailing Address Fax Number:
615-612-5605

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6601 SUGAR VALLEY DR
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37211-7091
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-419-3331
Provider Business Practice Location Address Fax Number:
615-612-5605
Provider Enumeration Date:
02/09/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GAVAMI
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
AFSHIN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
615-419-3331

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1855 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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