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General NPI Number Information
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NPI Number | 1790420982
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Entity Type | Organization
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Legal Business Name | VIVID EYES OPTOMETRY PLLC
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Dates
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Enumeration Date | 05/02/2022
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Last Update Date | 07/06/2022
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Provider Practice Location Address
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Address Line | 1001 OVER MOUNTAIN DR
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City | ELIZABETHTON
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State | TN
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Zip | 37643-2855
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Country | US
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Telephone | 423-268-1474
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Fax |
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Provider Business Mailing Address
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Address Line | 569 SUMMITT DR
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City | JOHNSON CITY
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State | TN
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Zip | 37604-2753
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | LINNEA STONECYPHER
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Credential | OD
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Telephone | 251-533-7168
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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 |
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License Number State |
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