Provider Demographics
NPI:1619309051
Name:OPTIQUE, PLLC.
Entity Type:Organization
Organization Name:OPTIQUE, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIEF MGR.
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:SONSINO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:615-321-4393
Mailing Address - Street 1:2817 WEST END AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203
Mailing Address - Country:US
Mailing Address - Phone:615-321-4393
Mailing Address - Fax:615-321-4392
Practice Address - Street 1:2817 WEST END AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203
Practice Address - Country:US
Practice Address - Phone:615-321-4393
Practice Address - Fax:615-321-4392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-08
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD2487152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103G708367Medicare UPIN
TN103G708367Medicare PIN