Provider Demographics
NPI:1588847834
Name:GREENEVILLE VISION CENTER
Entity Type:Organization
Organization Name:GREENEVILLE VISION CENTER
Other - Org Name:GREENEVILLE EYECARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:YANDELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:423-638-4151
Mailing Address - Street 1:PO BOX 425
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37744-0425
Mailing Address - Country:US
Mailing Address - Phone:423-638-4151
Mailing Address - Fax:423-639-6861
Practice Address - Street 1:204 EMORY RD
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745
Practice Address - Country:US
Practice Address - Phone:423-638-4151
Practice Address - Fax:423-639-6861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT1396152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN100022785OtherPHP
TN702006494OtherCARITEN HEALTHCARE
TN3137807Medicaid
TNP00332301OtherMEDICARE RAILROAD
TN3137807OtherBLUECROSS BLUESHIELD
TN3918780001Medicare NSC
TN3137807OtherBLUECROSS BLUESHIELD
TNP00332301OtherMEDICARE RAILROAD
TN3137807Medicaid
TN35984402Medicare Oscar/Certification