Provider Demographics
NPI:1073661716
Name:MABRY EYE CENTER PLLC
Entity Type:Organization
Organization Name:MABRY EYE CENTER PLLC
Other - Org Name:PREMIER EYEWEAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:D
Authorized Official - Last Name:MABRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-385-2020
Mailing Address - Street 1:1210 PREMIER DR
Mailing Address - Street 2:STE 110
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3747
Mailing Address - Country:US
Mailing Address - Phone:423-385-2020
Mailing Address - Fax:423-385-2021
Practice Address - Street 1:1210 PREMIER DR
Practice Address - Street 2:STE110
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3747
Practice Address - Country:US
Practice Address - Phone:423-385-2020
Practice Address - Fax:423-385-2021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5903040001Medicare NSC