Provider Demographics
NPI:1790883445
Name:IN TOUCH OPTICAL INC
Entity Type:Organization
Organization Name:IN TOUCH OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:GODUCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-339-9937
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:SIGNAL MTN
Mailing Address - State:TN
Mailing Address - Zip Code:37377
Mailing Address - Country:US
Mailing Address - Phone:423-339-9937
Mailing Address - Fax:423-339-9699
Practice Address - Street 1:2700 KEITH ST
Practice Address - Street 2:5
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312
Practice Address - Country:US
Practice Address - Phone:423-339-9937
Practice Address - Fax:423-339-9699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered156FX1201XEye and Vision Services ProvidersTechnician/TechnologistOptometric AssistantGroup - Single Specialty
Not Answered332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4582407Medicaid