1114157294 NPI number — THE FAMILY EYE SITE INC.

Table of content: (NPI 1114157294)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114157294 NPI number — THE FAMILY EYE SITE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE FAMILY EYE SITE INC.
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:
1114157294
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7174 BRUNSWICK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38002-9608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-351-1666
Provider Business Mailing Address Fax Number:
901-829-4102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1658 APPLING RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
CORDOVA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38016-4924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-379-2021
Provider Business Practice Location Address Fax Number:
901-385-2028
Provider Enumeration Date:
07/22/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HILLIS
Authorized Official First Name:
KRISTEN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
901-351-1666

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2690 , 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)





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