Provider Demographics
NPI:1558925586
Name:RJR PROPERTIES, PLLC
Entity Type:Organization
Organization Name:RJR PROPERTIES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDAL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:RABON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:423-943-8656
Mailing Address - Street 1:1061 ALLISON RD
Mailing Address - Street 2:
Mailing Address - City:PINEY FLATS
Mailing Address - State:TN
Mailing Address - Zip Code:37686-4023
Mailing Address - Country:US
Mailing Address - Phone:423-943-8656
Mailing Address - Fax:
Practice Address - Street 1:510 N MAIN AVE STE 2
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:TN
Practice Address - Zip Code:37650-1393
Practice Address - Country:US
Practice Address - Phone:423-943-8656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ019369Medicaid