Provider Demographics
NPI:1699834564
Name:ROGERSVILLE VISION CLINIC, PLLC
Entity type:Organization
Organization Name:ROGERSVILLE VISION CLINIC, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:H
Authorized Official - Last Name:ABERNATHY
Authorized Official - Suffix:JR
Authorized Official - Credentials:OPTOMETRIST
Authorized Official - Phone:865-573-2443
Mailing Address - Street 1:2020 CHAPMAN HWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1964
Mailing Address - Country:US
Mailing Address - Phone:865-573-2443
Mailing Address - Fax:865-573-3703
Practice Address - Street 1:2020 CHAPMAN HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1964
Practice Address - Country:US
Practice Address - Phone:865-573-2443
Practice Address - Fax:865-573-3703
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROGERSVILLE VISION CLINIC, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-07
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT738152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNA04960OtherEYEMED
62413OtherAVESIS
62413OtherAVESIS