Provider Demographics
NPI:1982764320
Name:CLANCY OPTICAL COMPANY
Entity Type:Organization
Organization Name:CLANCY OPTICAL COMPANY
Other - Org Name:SPEX CONTEMPORARY EYEWEAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:CLANCY
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:865-584-7739
Mailing Address - Street 1:4620 KINGSTON PIKE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-5230
Mailing Address - Country:US
Mailing Address - Phone:865-584-7739
Mailing Address - Fax:865-584-3624
Practice Address - Street 1:4620 KINGSTON PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5230
Practice Address - Country:US
Practice Address - Phone:865-584-7739
Practice Address - Fax:865-584-3624
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLANCY OPTICAL COMPANY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-08
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN93733332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN45152OtherSPECTERA
TN702013204OtherCARITEN SENIOR HEALTH
TNTN1348OtherEYEMED PROVIDER#
TNCL1533258OtherCLARITY VISION PROVIDER #
TN0009543OtherBC BS OF TN PIN NUMBER
TNTN1348OtherEYEMED PROVIDER#