Provider Demographics
NPI:1154865749
Name:BRIGHT EYES FAMILY EYE CARE PLLC
Entity Type:Organization
Organization Name:BRIGHT EYES FAMILY EYE CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:423-232-1428
Mailing Address - Street 1:1500 RYAN RD
Mailing Address - Street 2:
Mailing Address - City:FALL BRANCH
Mailing Address - State:TN
Mailing Address - Zip Code:37656-3418
Mailing Address - Country:US
Mailing Address - Phone:423-232-1428
Mailing Address - Fax:
Practice Address - Street 1:3060 FRANKLIN TER
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-4123
Practice Address - Country:US
Practice Address - Phone:423-232-1428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-15
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3167152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1558649491OtherINDIVIDUAL NPI