Provider Demographics
NPI:1306966692
Name:HORNER RAUSCH OPTICAL CO. EAST
Entity type:Organization
Organization Name:HORNER RAUSCH OPTICAL CO. EAST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLENNA
Authorized Official - Middle Name:B
Authorized Official - Last Name:FENN
Authorized Official - Suffix:
Authorized Official - Credentials:DPO
Authorized Official - Phone:615-226-0251
Mailing Address - Street 1:968 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37206-3614
Mailing Address - Country:US
Mailing Address - Phone:615-226-0251
Mailing Address - Fax:615-226-8527
Practice Address - Street 1:968 MAIN ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37206-3614
Practice Address - Country:US
Practice Address - Phone:615-226-0251
Practice Address - Fax:615-226-8527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN352156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0480150001Medicare ID - Type Unspecified