Provider Demographics
NPI:1225194475
Name:THOMAS L NUNNELEE INC
Entity Type:Organization
Organization Name:THOMAS L NUNNELEE INC
Other - Org Name:PRINCETON VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER OPTICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:JOELLA
Authorized Official - Last Name:JOHNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-389-9000
Mailing Address - Street 1:900 RUM RIVER DR SOUTH
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PRINCETON
Mailing Address - State:MN
Mailing Address - Zip Code:55371
Mailing Address - Country:US
Mailing Address - Phone:763-389-9000
Mailing Address - Fax:763-389-9096
Practice Address - Street 1:900 RUM RIVER DR SOUTH
Practice Address - Street 2:SUITE 103
Practice Address - City:PRINCETON
Practice Address - State:MN
Practice Address - Zip Code:55371
Practice Address - Country:US
Practice Address - Phone:763-389-9000
Practice Address - Fax:763-389-9096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC06562Medicare ID - Type Unspecified
MN0239750003Medicare NSC