Provider Demographics
NPI:1982679296
Name:CHATTANOOGA VISION CENTER, PLC
Entity Type:Organization
Organization Name:CHATTANOOGA VISION CENTER, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-870-4900
Mailing Address - Street 1:2158 NORTHGATE PARK LN
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-6957
Mailing Address - Country:US
Mailing Address - Phone:423-870-4900
Mailing Address - Fax:423-870-5889
Practice Address - Street 1:2158 NORTHGATE PARK LN
Practice Address - Street 2:SUITE 302
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37415-6957
Practice Address - Country:US
Practice Address - Phone:423-870-4900
Practice Address - Fax:423-870-5889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3711088Medicaid
=========OtherTAX ID
TN3711088Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
TN1187690001Medicare NSC
TN3711088Medicaid