Provider Demographics
NPI:1790835163
Name:FAMILY VISON AND CONTACT LENS CENTER
Entity Type:Organization
Organization Name:FAMILY VISON AND CONTACT LENS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:PARRISH
Authorized Official - Suffix:
Authorized Official - Credentials:DPO
Authorized Official - Phone:423-581-4295
Mailing Address - Street 1:3765 W ANDREW JOHNSON HWY
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-1101
Mailing Address - Country:US
Mailing Address - Phone:423-581-4295
Mailing Address - Fax:
Practice Address - Street 1:3765 W ANDREW JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-1101
Practice Address - Country:US
Practice Address - Phone:423-581-4295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPO496156FX1800X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0162127OtherBLUE CARE TENNCARE
0162127OtherBLUE CROSS BLUE SHIELD
TN702025890OtherCARITEN HEALTHCARE
TN0162127OtherTENNCARE SELECT
TN10042623OtherPHP TENNCARE
TN10042623OtherPHP TENNCARE