Provider Demographics
NPI:1750757936
Name:MINDSEYE OPTICAL, INC.
Entity type:Organization
Organization Name:MINDSEYE OPTICAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHLEMMER
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:931-388-9041
Mailing Address - Street 1:1301 TROTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-4702
Mailing Address - Country:US
Mailing Address - Phone:931-388-9041
Mailing Address - Fax:931-388-4254
Practice Address - Street 1:1301 TROTWOOD AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-4702
Practice Address - Country:US
Practice Address - Phone:931-388-9041
Practice Address - Fax:931-388-4254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-11
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDP2120332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier