Provider Demographics
NPI:1922471002
Name:ELIZABETHTON VISION AND CONTACT LENS CENTER INC
Entity Type:Organization
Organization Name:ELIZABETHTON VISION AND CONTACT LENS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:DEAL
Authorized Official - Last Name:PARRISH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:423-543-3421
Mailing Address - Street 1:114 S SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-3339
Mailing Address - Country:US
Mailing Address - Phone:423-543-3421
Mailing Address - Fax:423-543-7099
Practice Address - Street 1:114 S SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-3339
Practice Address - Country:US
Practice Address - Phone:423-543-3421
Practice Address - Fax:423-543-7099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-11
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNO.D.371152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ024600Medicaid
TNQ024600Medicaid
TN103G701261Medicare PIN