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General NPI Number Information
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NPI Number | 1598170037
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Entity Type | Organization
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Legal Business Name | HARDIN VALLEY EYECARE AND OPTICAL
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Dates
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Enumeration Date | 06/23/2014
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Last Update Date | 08/26/2014
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Provider Practice Location Address
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Address Line | 10904 SPRING BLUFF WAY
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City | KNOXVILLE
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State | TN
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Zip | 37932-1793
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Country | US
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Telephone | 865-246-1500
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Fax | 865-245-4522
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Provider Business Mailing Address
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Address Line | 10904 SPRING BLUFF WAY
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City | KNOXVILLE
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State | TN
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Zip | 37932-1793
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Country | US
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Telephone | 865-246-1500
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Fax | 865-245-4522
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. TRAVIS LEE THOMPSON
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Credential | OD
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Telephone | 865-705-1586
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 3122
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License Number State | TN
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