Provider Demographics
NPI:1497084255
Name:BRANCE E. HAGOOD
Entity Type:Organization
Organization Name:BRANCE E. HAGOOD
Other - Org Name:HAGOOD EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANCE
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:HAGOOD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:423-272-2345
Mailing Address - Street 1:215 W BROADWAY ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROGERSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37857-3280
Mailing Address - Country:US
Mailing Address - Phone:423-272-2345
Mailing Address - Fax:423-272-3324
Practice Address - Street 1:215 W BROADWAY ST
Practice Address - Street 2:SUITE A
Practice Address - City:ROGERSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37857-3280
Practice Address - Country:US
Practice Address - Phone:423-272-2345
Practice Address - Fax:423-272-3324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-08
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD0000001413152W00000X
TNOD001413332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3598321Medicaid
TN1274990001Medicare NSC
TN3598321Medicare PIN