Provider Demographics
NPI:1235256512
Name:SITES VISION CLINIC
Entity Type:Organization
Organization Name:SITES VISION CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:OPTOMETRIST
Authorized Official - Phone:931-647-5237
Mailing Address - Street 1:621 N RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-3127
Mailing Address - Country:US
Mailing Address - Phone:931-647-5237
Mailing Address - Fax:931-647-5254
Practice Address - Street 1:621 N RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-3127
Practice Address - Country:US
Practice Address - Phone:931-647-5237
Practice Address - Fax:931-647-5254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT1759152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103G701210Medicare PIN
TN6484380001Medicare NSC