Provider Demographics
NPI:1891968814
Name:LIMESTONE FAMILY EYE CENTER INC
Entity Type:Organization
Organization Name:LIMESTONE FAMILY EYE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:D
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-257-2340
Mailing Address - Street 1:364 OPIE ARNOLD RD
Mailing Address - Street 2:P O BOX 337
Mailing Address - City:LIMESTONE
Mailing Address - State:TN
Mailing Address - Zip Code:37681-2525
Mailing Address - Country:US
Mailing Address - Phone:423-257-2340
Mailing Address - Fax:423-257-8627
Practice Address - Street 1:364 OPIE ARNOLD RD
Practice Address - Street 2:
Practice Address - City:LIMESTONE
Practice Address - State:TN
Practice Address - Zip Code:37681-2525
Practice Address - Country:US
Practice Address - Phone:423-257-2340
Practice Address - Fax:423-257-8627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODTOO1064261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN35688044Medicare PIN