Provider Demographics
NPI:1992217756
Name:BEDFORD VISION AND EYE CLINIC PLLC
Entity Type:Organization
Organization Name:BEDFORD VISION AND EYE CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHAMBLIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:931-684-2197
Mailing Address - Street 1:915 COLLOREDO BLVD
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-2780
Mailing Address - Country:US
Mailing Address - Phone:931-684-2197
Mailing Address - Fax:931-684-8562
Practice Address - Street 1:915 COLLOREDO BLVD
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-2780
Practice Address - Country:US
Practice Address - Phone:931-684-2197
Practice Address - Fax:931-684-8562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-01
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1074152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty