Provider Demographics
NPI:1205014172
Name:PERFORMANCE EYECARE CLINIC, INC.
Entity Type:Organization
Organization Name:PERFORMANCE EYECARE CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:DEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:865-988-9787
Mailing Address - Street 1:501 ADESA BLVD.
Mailing Address - Street 2:SUITE B-200
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37771
Mailing Address - Country:US
Mailing Address - Phone:865-988-9787
Mailing Address - Fax:865-988-3832
Practice Address - Street 1:501 ADESA BLVD.
Practice Address - Street 2:SUITE B-200
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37771
Practice Address - Country:US
Practice Address - Phone:865-988-9787
Practice Address - Fax:865-988-3832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty