Provider Demographics
NPI:1801051750
Name:TRUELIGHT EYE CARE, PLLC
Entity type:Organization
Organization Name:TRUELIGHT EYE CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:ALLYSON
Authorized Official - Last Name:BOHLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:423-929-2020
Mailing Address - Street 1:2306 KNOB CREEK RD
Mailing Address - Street 2:#106
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2366
Mailing Address - Country:US
Mailing Address - Phone:423-929-2020
Mailing Address - Fax:423-929-3140
Practice Address - Street 1:2306 KNOB CREEK RD
Practice Address - Street 2:#106
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2366
Practice Address - Country:US
Practice Address - Phone:423-929-2020
Practice Address - Fax:423-929-3140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1663152W00000X
TN1296152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1801051750OtherGROUP PROVIDER -SUPPLIER NPI
TN1506422Medicaid
TN1801051750OtherGROUP PROVIDER -SUPPLIER NPI
TNU35837Medicare UPIN
TN1506422Medicaid
TNU46424Medicare UPIN