Provider Demographics
NPI:1730750696
Name:THE EYE CLINIC OF GOODLETTSVILLE, PC
Entity type:Organization
Organization Name:THE EYE CLINIC OF GOODLETTSVILLE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:JUDD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:615-859-1912
Mailing Address - Street 1:900 CONFERENCE DR STE 15B
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-1909
Mailing Address - Country:US
Mailing Address - Phone:615-859-1912
Mailing Address - Fax:
Practice Address - Street 1:900 CONFERENCE DR STE 15B
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-1909
Practice Address - Country:US
Practice Address - Phone:615-859-1912
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1467553867OtherNPI