Provider Demographics
NPI:1851420954
Name:EYE ASSOCIATES OPTICAL, LLC.
Entity Type:Organization
Organization Name:EYE ASSOCIATES OPTICAL, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:BOB
Authorized Official - Last Name:MAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-461-0222
Mailing Address - Street 1:926 N JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-2332
Mailing Address - Country:US
Mailing Address - Phone:931-461-0222
Mailing Address - Fax:931-393-4156
Practice Address - Street 1:926 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-2332
Practice Address - Country:US
Practice Address - Phone:931-461-0222
Practice Address - Fax:931-393-4156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1521802Medicaid