Provider Demographics
NPI:1235357542
Name:UPTOWN VISION CENTER & OPTICAL, LLC
Entity Type:Organization
Organization Name:UPTOWN VISION CENTER & OPTICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-265-4306
Mailing Address - Street 1:PO BOX 1636
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37401
Mailing Address - Country:US
Mailing Address - Phone:423-265-4306
Mailing Address - Fax:423-265-4404
Practice Address - Street 1:629 MARKET ST
Practice Address - Street 2:SUITE 115
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402-4884
Practice Address - Country:US
Practice Address - Phone:423-265-4306
Practice Address - Fax:423-265-4404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3942008Medicare PIN
TN3944994Medicare PIN
TN10341I4816Medicare PIN
TN4443590001Medicare NSC
TNU71360Medicare UPIN