Provider Demographics
NPI:1457847782
Name:RICE MOBILE OD TN LLC
Entity Type:Organization
Organization Name:RICE MOBILE OD TN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-244-2441
Mailing Address - Street 1:12910 SHELBYVILLE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-2404
Mailing Address - Country:US
Mailing Address - Phone:502-244-2441
Mailing Address - Fax:502-254-4069
Practice Address - Street 1:304 ORCHARD DR
Practice Address - Street 2:
Practice Address - City:SOUTH FULTON
Practice Address - State:TN
Practice Address - Zip Code:38257-2456
Practice Address - Country:US
Practice Address - Phone:502-244-2441
Practice Address - Fax:502-254-4069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH662152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty