Provider Demographics
NPI:1114351707
Name:EPIC OPTICAL, LLC
Entity Type:Organization
Organization Name:EPIC OPTICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMIAH
Authorized Official - Middle Name:C
Authorized Official - Last Name:DELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:423-265-2365
Mailing Address - Street 1:801 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37402-2511
Mailing Address - Country:US
Mailing Address - Phone:423-265-2365
Mailing Address - Fax:423-756-5933
Practice Address - Street 1:801 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402-2511
Practice Address - Country:US
Practice Address - Phone:423-265-2365
Practice Address - Fax:423-756-5933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty