Healthcare Provider Details

I. General information

NPI: 1336230077
Provider Name (Legal Business Name): ASSOCIATES IN EYE CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2523 JACKSBORO PK
JACKSBORO TN
37757-4847
US

IV. Provider business mailing address

PO BOX 306
FERGUSON KY
42533-0306
US

V. Phone/Fax

Practice location:
  • Phone: 423-566-2020
  • Fax: 423-566-4245
Mailing address:
  • Phone: 606-492-2211
  • Fax: 606-676-0873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GARY WALTER UPCHURCH
Title or Position: PRESIDENT AND AUTHORIZED OFFICIAL
Credential: OD
Phone: 606-387-5612