Provider Demographics
NPI:1467625533
Name:DOWNTOWN VISION CENTER, P.C.
Entity Type:Organization
Organization Name:DOWNTOWN VISION CENTER, P.C.
Other - Org Name:WILLIAM MALEC & ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:MALEC
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:731-422-3811
Mailing Address - Street 1:1239 VANN DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-6024
Mailing Address - Country:US
Mailing Address - Phone:731-422-3811
Mailing Address - Fax:731-422-5681
Practice Address - Street 1:1239 VANN DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-6024
Practice Address - Country:US
Practice Address - Phone:731-422-3811
Practice Address - Fax:731-422-5681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT1173152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3598725Medicaid
3598725Medicare PIN
TN3598725Medicaid