Provider Demographics
NPI:1073791406
Name:LISA K PRIVETT FAMILY EYE CARE
Entity Type:Organization
Organization Name:LISA K PRIVETT FAMILY EYE CARE
Other - Org Name:FAMILY EYE CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIVETT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:731-696-4004
Mailing Address - Street 1:140 S BELLS ST
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:TN
Mailing Address - Zip Code:38001-1732
Mailing Address - Country:US
Mailing Address - Phone:731-696-4004
Mailing Address - Fax:731-696-4009
Practice Address - Street 1:135 S BELLS ST
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:TN
Practice Address - Zip Code:38001-1779
Practice Address - Country:US
Practice Address - Phone:731-696-4004
Practice Address - Fax:731-696-4009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
TNT1481332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1014720001Medicare NSC
TNU44918Medicare UPIN
TN3598962Medicare PIN