Healthcare Provider Details

I. General information

NPI: 1083854814
Provider Name (Legal Business Name): LUKE ONE VISION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2009
Last Update Date: 03/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 EWINGVILLE DR
FRANKLIN TN
37064-3217
US

IV. Provider business mailing address

131 EWINGVILLE DR
FRANKLIN TN
37064-3217
US

V. Phone/Fax

Practice location:
  • Phone: 615-419-3331
  • Fax:
Mailing address:
  • Phone: 615-419-3331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberODT 1855
License Number StateTN

VIII. Authorized Official

Name: DAVID AFSHIN GAVAMI
Title or Position: PRESIDENT
Credential: OD
Phone: 615-419-3331