Provider Demographics
NPI:1396525531
Name:AURA OPTICAL
Entity type:Organization
Organization Name:AURA OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAUDEWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:423-407-3311
Mailing Address - Street 1:312 E MAIN ST UNIT 100
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-5733
Mailing Address - Country:US
Mailing Address - Phone:423-407-3311
Mailing Address - Fax:423-707-2299
Practice Address - Street 1:312 E MAIN ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-5733
Practice Address - Country:US
Practice Address - Phone:423-863-1447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-04
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty