Provider Demographics
NPI:1447481650
Name:COMPLETE FAMILY EYECARE, INC.
Entity type:Organization
Organization Name:COMPLETE FAMILY EYECARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:731-968-5225
Mailing Address - Street 1:185 BOSWELL ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38351-1597
Mailing Address - Country:US
Mailing Address - Phone:731-968-5225
Mailing Address - Fax:731-967-3291
Practice Address - Street 1:185 BOSWELL ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:TN
Practice Address - Zip Code:38351-1597
Practice Address - Country:US
Practice Address - Phone:731-968-5225
Practice Address - Fax:731-967-3291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-05
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT2904152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4236026OtherBCBS
TN1518906Medicaid
TN6381990001Medicare NSC
TN1518906Medicaid