Provider Demographics
NPI:1104858273
Name:OAK RIDGE OPTICAL DISPENSARY
Entity Type:Organization
Organization Name:OAK RIDGE OPTICAL DISPENSARY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN/CO OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:D
Authorized Official - Last Name:ARNDT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:865-483-3616
Mailing Address - Street 1:174 RANDOLPH RD
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-5027
Mailing Address - Country:US
Mailing Address - Phone:865-483-3616
Mailing Address - Fax:865-483-7611
Practice Address - Street 1:174 RANDOLPH RD
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-5027
Practice Address - Country:US
Practice Address - Phone:865-483-3616
Practice Address - Fax:865-483-7611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD1118156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1104858273Medicare NSC