Provider Demographics
NPI:1427228188
Name:BRIAN B DUBES OD PC
Entity Type:Organization
Organization Name:BRIAN B DUBES OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:DUBES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:865-660-0036
Mailing Address - Street 1:451 EXECUTIVE MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37771-6781
Mailing Address - Country:US
Mailing Address - Phone:865-660-0036
Mailing Address - Fax:931-484-4855
Practice Address - Street 1:1341 N MAIN ST
Practice Address - Street 2:STE 1
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-6089
Practice Address - Country:US
Practice Address - Phone:931-484-6546
Practice Address - Fax:931-484-4855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-08
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2253152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT 01138Medicare UPIN
TN3945351Medicare PIN