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General NPI Number Information
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NPI Number | 1043550916
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Entity Type | Organization
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Legal Business Name | ENVISION FAMILY EYECARE, PLLC
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Dates
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Enumeration Date | 02/28/2013
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Last Update Date | 11/30/2016
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Provider Practice Location Address
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Address Line | 333 E HARPER AVE
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City | MARYVILLE
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State | TN
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Zip | 37804-5724
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Country | US
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Telephone | 865-982-6110
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Fax | 865-977-7243
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Provider Business Mailing Address
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Address Line | 333 E HARPER AVE
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City | MARYVILLE
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State | TN
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Zip | 37804-5724
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Country | US
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Telephone | 865-982-6110
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Fax | 865-977-7243
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | GARY L VINES
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Credential |
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Telephone | 865-982-6110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | ODT1895
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License Number State | TN
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