Provider Demographics
NPI:1871737734
Name:LINDA'S EYEWEAR
Entity type:Organization
Organization Name:LINDA'S EYEWEAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPO
Authorized Official - Phone:865-977-0285
Mailing Address - Street 1:312 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-5800
Mailing Address - Country:US
Mailing Address - Phone:865-977-0285
Mailing Address - Fax:865-977-1459
Practice Address - Street 1:312 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5800
Practice Address - Country:US
Practice Address - Phone:865-977-0285
Practice Address - Fax:865-977-1459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPO719156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1216240001Medicare PIN