Provider Demographics
NPI:1497190581
Name:THE OPTICAL SHOPPE PLLC
Entity Type:Organization
Organization Name:THE OPTICAL SHOPPE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:TRAPENI
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:615-459-0675
Mailing Address - Street 1:23 N LOWRY ST
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-2525
Mailing Address - Country:US
Mailing Address - Phone:615-459-0675
Mailing Address - Fax:615-459-6401
Practice Address - Street 1:23 N LOWRY ST
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-2525
Practice Address - Country:US
Practice Address - Phone:615-459-0675
Practice Address - Fax:615-459-6401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT941152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0071007Medicaid
TN35956621Medicare PIN
TN0071007Medicaid
TNT61263Medicare UPIN