Healthcare Provider Details

I. General information

NPI: 1790835163
Provider Name (Legal Business Name): FAMILY VISON AND CONTACT LENS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 10/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3765 W ANDREW JOHNSON HWY
MORRISTOWN TN
37814-1101
US

IV. Provider business mailing address

3765 W ANDREW JOHNSON HWY
MORRISTOWN TN
37814-1101
US

V. Phone/Fax

Practice location:
  • Phone: 423-581-4295
  • Fax:
Mailing address:
  • Phone: 423-581-4295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberDPO496
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberDPO496
License Number StateTN

VIII. Authorized Official

Name: MR. BENJAMIN SCOTT PARRISH
Title or Position: OWNER OPTICIAN
Credential: DPO
Phone: 423-581-4295