Provider Demographics
NPI:1235597543
Name:PRICE EYE ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:PRICE EYE ASSOCIATES, PLLC
Other - Org Name:PORT ROYAL EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:JUDKINS
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:408-605-0077
Mailing Address - Street 1:4886 PORT ROYAL RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-2975
Mailing Address - Country:US
Mailing Address - Phone:931-489-6118
Mailing Address - Fax:931-451-7416
Practice Address - Street 1:4886 PORT ROYAL RD
Practice Address - Street 2:SUITE 150
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-2975
Practice Address - Country:US
Practice Address - Phone:931-489-6118
Practice Address - Fax:931-451-7416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-01
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2766152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT68957Medicare UPIN