Healthcare Provider Details

I. General information

NPI: 1487689311
Provider Name (Legal Business Name): EYEAR OPTICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 BATTLECREEK RD
SOUTH PITTSBURG TN
37380-6308
US

IV. Provider business mailing address

104 BATTLECREEK RD
SOUTH PITTSBURG TN
37380-6308
US

V. Phone/Fax

Practice location:
  • Phone: 423-837-5334
  • Fax: 423-837-5334
Mailing address:
  • Phone: 423-837-5334
  • Fax: 423-837-5334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number144
License Number StateTN

VIII. Authorized Official

Name: CINDY C HENDERSON
Title or Position: OWNER
Credential: LDO
Phone: 423-877-9990