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General NPI Number Information
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NPI Number | 1699834564
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Entity Type | Organization
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Legal Business Name | ROGERSVILLE VISION CLINIC, PLLC
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Dates
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Enumeration Date | 12/07/2006
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Last Update Date | 04/18/2011
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Provider Practice Location Address
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Address Line | 2020 CHAPMAN HWY SUITE 1
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City | KNOXVILLE
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State | TN
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Zip | 37920-1964
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Country | US
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Telephone | 865-573-2443
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Fax | 865-573-3703
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Provider Business Mailing Address
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Address Line | 2020 CHAPMAN HWY SUITE 1
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City | KNOXVILLE
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State | TN
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Zip | 37920-1964
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Country | US
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Telephone | 865-573-2443
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Fax | 865-573-3703
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Authorized Official
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Title or Position | OWNER
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Name | MR. EDDIE H ABERNATHY JR.
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Credential | OPTOMETRIST
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Telephone | 865-573-2443
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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 | ODT738
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License Number State | TN
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