Provider Demographics
NPI:1083819668
Name:FAMILY EYE CARE OF CLARKSVILLE PLLC
Entity Type:Organization
Organization Name:FAMILY EYE CARE OF CLARKSVILLE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAZEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-648-0544
Mailing Address - Street 1:1492 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-8625
Mailing Address - Country:US
Mailing Address - Phone:931-648-0544
Mailing Address - Fax:931-648-3625
Practice Address - Street 1:1492 MADISON ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-8625
Practice Address - Country:US
Practice Address - Phone:931-648-0544
Practice Address - Fax:931-648-3625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3599631Medicaid
TN3599631Medicare ID - Type Unspecified
TN1022340001Medicare NSC