1588847834 NPI number — GREENEVILLE VISION CENTER

Table of content: (NPI 1588847834)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588847834 NPI number — GREENEVILLE VISION CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREENEVILLE VISION CENTER
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:
6
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:
1588847834
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 425
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENEVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37744-0425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-638-4151
Provider Business Mailing Address Fax Number:
423-639-6861

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
204 EMORY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENEVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-638-4151
Provider Business Practice Location Address Fax Number:
423-639-6861
Provider Enumeration Date:
12/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
YANDELL
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
423-638-4151

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  ODT1396 , 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: 100022785 . This is a "PHP" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 702006494 . This is a "CARITEN HEALTHCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3137807 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00332301 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3137807 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com