Provider Demographics
NPI:1932396371
Name:ENVISION FAMILY EYE CARE, PLLC
Entity Type:Organization
Organization Name:ENVISION FAMILY EYE CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:VINES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:865-982-6110
Mailing Address - Street 1:333 E HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-5724
Mailing Address - Country:US
Mailing Address - Phone:865-982-6110
Mailing Address - Fax:865-977-7243
Practice Address - Street 1:333 E HARPER AVE
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5724
Practice Address - Country:US
Practice Address - Phone:865-982-6110
Practice Address - Fax:865-977-7243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT-1895152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1790877975OtherNPI INDIVIDUAL
TN185143036OtherNPI INDIVIDUAL
TN1962471789OtherNPI INDIVIDUAL
TN3943766Medicare PIN
TN3591199Medicare PIN
TN185143036OtherNPI INDIVIDUAL
TN1962471789OtherNPI INDIVIDUAL
TN1790877975OtherNPI INDIVIDUAL
TN3943757Medicare PIN