Provider Demographics
NPI:1316009319
Name:RIVER VALLEY EYE CLINIC P C
Entity type:Organization
Organization Name:RIVER VALLEY EYE CLINIC P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-296-1990
Mailing Address - Street 1:215 HOLLY LN
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:TN
Mailing Address - Zip Code:37185-3387
Mailing Address - Country:US
Mailing Address - Phone:931-296-1990
Mailing Address - Fax:931-296-1899
Practice Address - Street 1:215 HOLLY LN
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:TN
Practice Address - Zip Code:37185-1531
Practice Address - Country:US
Practice Address - Phone:931-296-1990
Practice Address - Fax:931-296-1899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD0000002255152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3719356Medicaid
TNU91213Medicare UPIN
TN3719356Medicaid
TN3719356Medicare PIN