Provider Demographics
NPI:1790939197
Name:ROGERSVILLE VISION CLINIC,PLLC
Entity Type:Organization
Organization Name:ROGERSVILLE VISION CLINIC,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KATY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-272-2020
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37857-0160
Mailing Address - Country:US
Mailing Address - Phone:423-272-2020
Mailing Address - Fax:423-272-5886
Practice Address - Street 1:311 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37857-3348
Practice Address - Country:US
Practice Address - Phone:423-272-2020
Practice Address - Fax:423-272-5886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-12
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT 738152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1509536Medicaid
TN35944891Medicare PIN
TN6169380001Medicare NSC