Healthcare Provider Details

I. General information

NPI: 1922471002
Provider Name (Legal Business Name): ELIZABETHTON VISION AND CONTACT LENS CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2015
Last Update Date: 12/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 S SYCAMORE ST
ELIZABETHTON TN
37643-3339
US

IV. Provider business mailing address

114 S SYCAMORE ST
ELIZABETHTON TN
37643-3339
US

V. Phone/Fax

Practice location:
  • Phone: 423-543-3421
  • Fax: 423-543-7099
Mailing address:
  • Phone: 423-543-3421
  • Fax: 423-543-7099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberO.D.371
License Number StateTN

VIII. Authorized Official

Name: DR. BEN DEAL PARRISH
Title or Position: PRESIDENT
Credential: O.D.
Phone: 423-543-3421