Provider Demographics
NPI:1700050648
Name:CLANCY OPTICAL COMPANY
Entity Type:Organization
Organization Name:CLANCY OPTICAL COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:CLANCY
Authorized Official - Suffix:
Authorized Official - Credentials:DPO
Authorized Official - Phone:865-584-3624
Mailing Address - Street 1:4620 KINGSTON PIKE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-5230
Mailing Address - Country:US
Mailing Address - Phone:865-584-7739
Mailing Address - Fax:865-584-3624
Practice Address - Street 1:9700 KINGSTON PIKE
Practice Address - Street 2:STE 15
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3340
Practice Address - Country:US
Practice Address - Phone:865-539-2835
Practice Address - Fax:865-539-3737
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLANCY OPTICAL COMPANY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN93734332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier