Provider Demographics
NPI:1366480964
Name:DR. TORREY J. CARLSON & ASSOCIATES
Entity Type:Organization
Organization Name:DR. TORREY J. CARLSON & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TORREY
Authorized Official - Middle Name:JON
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:423-246-1585
Mailing Address - Street 1:2101 FORT HENRY DR
Mailing Address - Street 2:SPACE E-9
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-3658
Mailing Address - Country:US
Mailing Address - Phone:423-246-1585
Mailing Address - Fax:423-246-9913
Practice Address - Street 1:2101 FORT HENRY DR
Practice Address - Street 2:SPACE E-9
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-3658
Practice Address - Country:US
Practice Address - Phone:423-246-1585
Practice Address - Fax:423-246-9913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1695152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4073509OtherBCBS OF TN
TN3722758Medicare ID - Type Unspecified