Provider Demographics
NPI:1770608622
Name:SUMMIT EYE ASSOCIATES OPTICAL LLC
Entity type:Organization
Organization Name:SUMMIT EYE ASSOCIATES OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-883-2356
Mailing Address - Street 1:5410 OLD HICKORY BLVD
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2574
Mailing Address - Country:US
Mailing Address - Phone:615-883-2356
Mailing Address - Fax:615-872-0863
Practice Address - Street 1:5410 OLD HICKORY BLVD
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2574
Practice Address - Country:US
Practice Address - Phone:615-883-2356
Practice Address - Fax:615-872-0863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1264980001Medicare ID - Type Unspecified