Provider Demographics
NPI:1619926359
Name:OPTICAL INVESTMENT INC.
Entity Type:Organization
Organization Name:OPTICAL INVESTMENT INC.
Other - Org Name:DICKERSON EYE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:DICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:931-381-4911
Mailing Address - Street 1:840 HATCHER LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-3528
Mailing Address - Country:US
Mailing Address - Phone:931-381-4911
Mailing Address - Fax:931-381-0966
Practice Address - Street 1:840 HATCHER LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-3528
Practice Address - Country:US
Practice Address - Phone:931-381-4911
Practice Address - Fax:931-381-0966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT612152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0696400001OtherDME#
TN3593711Medicare ID - Type Unspecified
TN0696400001OtherDME#
TN0696400001Medicare NSC