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General NPI Number Information
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NPI Number | 1841537107
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Entity Type | Organization
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Legal Business Name | THE EYEGLASS PLACE
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Dates
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Enumeration Date | 01/07/2013
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Last Update Date | 01/07/2013
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Provider Practice Location Address
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Address Line | 8079 KINGSTON PIKE STE P
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City | KNOXVILLE
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State | TN
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Zip | 37919-3909
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Country | US
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Telephone | 865-531-1048
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Fax | 865-670-4189
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Provider Business Mailing Address
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Address Line | 8079 KINGSTON PIKE STE P
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City | KNOXVILLE
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State | TN
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Zip | 37919-3909
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Country | US
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Telephone | 865-531-1048
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Fax | 865-670-4189
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Authorized Official
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Title or Position | OWNER
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Name | MARK CRAWLEY
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Credential | LDO
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Telephone | 865-531-1048
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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 | 1473
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License Number State | TN
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