Provider Demographics
NPI:1912167370
Name:MCCORD OPTICAL SERVICES
Entity Type:Organization
Organization Name:MCCORD OPTICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCCORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-538-0606
Mailing Address - Street 1:5661 HWY 11 E
Mailing Address - Street 2:ST 2 MCCORD OPTICAL SERVICES
Mailing Address - City:PINEY FLATS
Mailing Address - State:TN
Mailing Address - Zip Code:37618
Mailing Address - Country:US
Mailing Address - Phone:423-538-0606
Mailing Address - Fax:423-538-0200
Practice Address - Street 1:5661 HWY 11 E
Practice Address - Street 2:ST 2 MCCORD OPTICAL SERVICES
Practice Address - City:PINEY FLATS
Practice Address - State:TN
Practice Address - Zip Code:37618
Practice Address - Country:US
Practice Address - Phone:423-538-0606
Practice Address - Fax:423-538-0200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD270152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty