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General NPI Number Information
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NPI Number | 1154865749
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Entity Type | Organization
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Legal Business Name | BRIGHT EYES FAMILY EYE CARE PLLC
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Dates
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Enumeration Date | 12/15/2016
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Last Update Date | 01/12/2017
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Provider Practice Location Address
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Address Line | 3060 FRANKLIN TER
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City | JOHNSON CITY
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State | TN
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Zip | 37604-4123
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Country | US
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Telephone | 423-232-1428
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 RYAN RD
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City | FALL BRANCH
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State | TN
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Zip | 37656-3418
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Country | US
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Telephone | 423-232-1428
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIC PHYSICIAN
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Name | DR. BEN LAWRENCE
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Credential | OD
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Telephone | 423-232-1428
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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 | 3167
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License Number State | TN
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