Provider Demographics
NPI:1760500821
Name:PRIMARY EYECARE GROUP, P.C.
Entity Type:Organization
Organization Name:PRIMARY EYECARE GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:LUNSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-373-0080
Mailing Address - Street 1:205 WARD CIR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7552
Mailing Address - Country:US
Mailing Address - Phone:615-373-0080
Mailing Address - Fax:615-373-2848
Practice Address - Street 1:205 WARD CIR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7552
Practice Address - Country:US
Practice Address - Phone:615-373-0080
Practice Address - Fax:615-373-2848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD0000001488152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU77104Medicare UPIN
TN3599897Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
TN0743690001Medicare NSC
TNU45808Medicare UPIN