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General NPI Number Information
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NPI Number | 1750757936
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Entity Type | Organization
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Legal Business Name | MINDSEYE OPTICAL, INC.
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Dates
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Enumeration Date | 08/11/2015
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Last Update Date | 08/12/2015
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Provider Practice Location Address
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Address Line | 1301 TROTWOOD AVE
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City | COLUMBIA
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State | TN
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Zip | 38401-4702
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Country | US
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Telephone | 931-388-9041
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Fax | 931-388-4254
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Provider Business Mailing Address
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Address Line | 1301 TROTWOOD AVE
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City | COLUMBIA
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State | TN
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Zip | 38401-4702
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Country | US
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Telephone | 931-388-9041
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Fax | 931-388-4254
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Authorized Official
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Title or Position | OWNER
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Name | MR. ANTHONY SCHLEMMER
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Credential | L.D.O.
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Telephone | 931-388-9041
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | DP2120
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License Number State | TN
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