Provider Demographics
NPI:1104140508
Name:CCN OPTICAL SERVICES LLC
Entity type:Organization
Organization Name:CCN OPTICAL SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DEMPSEY
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:615-320-3937
Mailing Address - Street 1:2400 PATTERSON ST
Mailing Address - Street 2:#201
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1562
Mailing Address - Country:US
Mailing Address - Phone:615-320-3937
Mailing Address - Fax:
Practice Address - Street 1:2400 PATTERSON ST
Practice Address - Street 2:#201
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1562
Practice Address - Country:US
Practice Address - Phone:615-320-3937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMC15763332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier