Provider Demographics
NPI:1487689311
Name:EYEAR OPTICAL, INC.
Entity Type:Organization
Organization Name:EYEAR OPTICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:C
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:423-877-9990
Mailing Address - Street 1:104 BATTLECREEK RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH PITTSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37380-6308
Mailing Address - Country:US
Mailing Address - Phone:423-837-5334
Mailing Address - Fax:423-837-5334
Practice Address - Street 1:104 BATTLECREEK RD
Practice Address - Street 2:
Practice Address - City:SOUTH PITTSBURG
Practice Address - State:TN
Practice Address - Zip Code:37380-6308
Practice Address - Country:US
Practice Address - Phone:423-837-5334
Practice Address - Fax:423-837-5334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN144332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4097412Medicaid
0758330002Medicare NSC