1306014170 NPI number — CHRISTOPHER OPTICAL

Table of content: (NPI 1306014170)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306014170 NPI number — CHRISTOPHER OPTICAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRISTOPHER OPTICAL
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:
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:
1306014170
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 COVEY DR
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37067-5063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-791-0953
Provider Business Mailing Address Fax Number:
615-791-0121

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 COVEY DR
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37067-5063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-791-0953
Provider Business Practice Location Address Fax Number:
615-791-0121
Provider Enumeration Date:
02/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MCWHORTER
Authorized Official First Name:
CHRIS
Authorized Official Middle Name:
KENT
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
615-791-0953

Provider Taxonomy Codes

  • Taxonomy code: 156FX1800X , with the licence number:  DPO0000000837 , 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)

  • Identifier: 1B0098164 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 6154358180 . This is a "VSP" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 36394 . This is a "DAVIS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: TN0837 . This is a "EYE MED" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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