Provider Demographics
NPI:1609546720
Name:TOTAL VISION OPTICAL PLLC
Entity Type:Organization
Organization Name:TOTAL VISION OPTICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:KENDALL
Authorized Official - Last Name:CECIL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:606-949-1911
Mailing Address - Street 1:41 TRIANGLE ST
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:KY
Mailing Address - Zip Code:41649-7992
Mailing Address - Country:US
Mailing Address - Phone:606-949-1911
Mailing Address - Fax:606-949-1910
Practice Address - Street 1:41 TRIANGLE ST
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:KY
Practice Address - Zip Code:41649-7992
Practice Address - Country:US
Practice Address - Phone:606-949-1911
Practice Address - Fax:606-949-1910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty