Healthcare Provider Details

I. General information

NPI: 1972773349
Provider Name (Legal Business Name): LOW VISION CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2008
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 E WEISGARBER RD SUITE 204
KNOXVILLE TN
37909-2686
US

IV. Provider business mailing address

1124 E WEISGARBER RD SUITE 204
KNOXVILLE TN
37909-2686
US

V. Phone/Fax

Practice location:
  • Phone: 865-522-2449
  • Fax: 865-522-6453
Mailing address:
  • Phone: 865-522-2449
  • Fax: 865-522-6453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number1593OD
License Number StateTN

VIII. Authorized Official

Name: DR. BRUCE D. GILLILAND
Title or Position: PRESIDENT
Credential: O.D.
Phone: 865-522-2449