Provider Demographics
NPI:1689726358
Name:MURFREESBORO OPTICAL DISPENSARY
Entity Type:Organization
Organization Name:MURFREESBORO OPTICAL DISPENSARY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-896-2725
Mailing Address - Street 1:702 E CLARK BLVD
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-2323
Mailing Address - Country:US
Mailing Address - Phone:615-896-2725
Mailing Address - Fax:615-890-9813
Practice Address - Street 1:702 E CLARK BLVD
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-2323
Practice Address - Country:US
Practice Address - Phone:615-896-2725
Practice Address - Fax:615-890-9813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPO0000000516332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0262760001Medicare ID - Type Unspecified
TN02000372Medicare UPIN