Provider Demographics
NPI:1225407158
Name:OPTICAL MARKET, INC.
Entity Type:Organization
Organization Name:OPTICAL MARKET, INC.
Other - Org Name:N/A
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:865-922-3937
Mailing Address - Street 1:1053 N CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-6449
Mailing Address - Country:US
Mailing Address - Phone:865-922-3937
Mailing Address - Fax:865-922-8412
Practice Address - Street 1:1053 N CENTRAL ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-6449
Practice Address - Country:US
Practice Address - Phone:865-922-3937
Practice Address - Fax:865-922-8412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTOD2347152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3945379Medicaid