1780626168 NPI number — PARIS EYE CARE, LLC

Table of content: (NPI 1780626168)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780626168 NPI number — PARIS EYE CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARIS EYE CARE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PARIS EYE CARE
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780626168
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
460 TARA LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTINGDON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38344-2110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
731-641-0991
Provider Business Mailing Address Fax Number:
731-644-2649

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1210 MINERAL WELLS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38242-4914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-641-0991
Provider Business Practice Location Address Fax Number:
731-644-2649
Provider Enumeration Date:
06/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NICHOLSON
Authorized Official First Name:
LARRY
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
BUSINESS OWNER
Authorized Official Telephone Number:
731-641-0991

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2544 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)