Provider Demographics
NPI:1265632301
Name:WINCHESTER EYE CLINIC P.C.
Entity Type:Organization
Organization Name:WINCHESTER EYE CLINIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MARLIN
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:931-967-2230
Mailing Address - Street 1:183 HOSPITAL RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-2470
Mailing Address - Country:US
Mailing Address - Phone:931-967-2230
Mailing Address - Fax:931-967-9622
Practice Address - Street 1:183 HOSPITAL RD
Practice Address - Street 2:SUITE H
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-6207
Practice Address - Country:US
Practice Address - Phone:931-967-2230
Practice Address - Fax:931-967-9622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000494152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3722905Medicaid
TN3722905OtherMEDICARE PROVIDER NUMBER
TN3722905Medicare PIN