Provider Demographics
NPI:1295854511
Name:VISION PLUS OPTICAL
Entity type:Organization
Organization Name:VISION PLUS OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:423-332-5331
Mailing Address - Street 1:9453 DAYTON PIKE
Mailing Address - Street 2:
Mailing Address - City:SODDY DAISY
Mailing Address - State:TN
Mailing Address - Zip Code:37379-4751
Mailing Address - Country:US
Mailing Address - Phone:423-332-5331
Mailing Address - Fax:423-332-5331
Practice Address - Street 1:9453 DAYTON PIKE
Practice Address - Street 2:
Practice Address - City:SODDY DAISY
Practice Address - State:TN
Practice Address - Zip Code:37379-4751
Practice Address - Country:US
Practice Address - Phone:423-332-5331
Practice Address - Fax:423-332-5331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN917332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNTN0917OtherEYE MED
TN189507OtherBLUE CARE
TN189507OtherBLUE CROSS BLUE SHIELD
TN0831780001Medicare ID - Type UnspecifiedMEDICARE