Provider Demographics
NPI:1598808909
Name:TULLAHOMA VISION ASSOCIATES P C
Entity Type:Organization
Organization Name:TULLAHOMA VISION ASSOCIATES P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:SHAWN
Authorized Official - Last Name:MCBRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:931-455-0654
Mailing Address - Street 1:105 W BLACKWELL ST
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-3555
Mailing Address - Country:US
Mailing Address - Phone:931-455-0654
Mailing Address - Fax:931-455-0669
Practice Address - Street 1:105 W BLACKWELL ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-3555
Practice Address - Country:US
Practice Address - Phone:931-455-0654
Practice Address - Fax:931-455-0669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1275670001Medicare NSC