Provider Demographics
NPI:1003089731
Name:J LANCASTER ROSE JR
Entity Type:Organization
Organization Name:J LANCASTER ROSE JR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:J
Authorized Official - Middle Name:LANCASTER
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:931-359-1467
Mailing Address - Street 1:435 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37091-3351
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:435 CEDAR ST
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:TN
Practice Address - Zip Code:37091-3351
Practice Address - Country:US
Practice Address - Phone:931-359-1467
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3596313Medicaid
TN0077625OtherBCBS
TN0077625OtherBCBS
TN3596313Medicare PIN
TN3596313Medicaid