Provider Demographics
NPI:1811608359
Name:CUTTING EDGE OPTICAL, LLC
Entity type:Organization
Organization Name:CUTTING EDGE OPTICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:931-488-5778
Mailing Address - Street 1:875 UNION STREET
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160
Mailing Address - Country:US
Mailing Address - Phone:931-488-5778
Mailing Address - Fax:
Practice Address - Street 1:875 UNION STREET
Practice Address - Street 2:SUITE 103
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160
Practice Address - Country:US
Practice Address - Phone:931-488-5778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-06
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty