Provider Demographics
NPI:1699889899
Name:HALLS VISION CLINIC, INC.
Entity type:Organization
Organization Name:HALLS VISION CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:LOUTHAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:865-922-7765
Mailing Address - Street 1:4626 MILL BRANCH LANE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37938-3200
Mailing Address - Country:US
Mailing Address - Phone:865-922-7765
Mailing Address - Fax:865-922-7766
Practice Address - Street 1:4626 MILL BRANCH LANE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37938-3200
Practice Address - Country:US
Practice Address - Phone:865-922-7765
Practice Address - Fax:865-922-7766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT1575152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3944242Medicare PIN
TN6205460001Medicare NSC
TNX58829Medicare UPIN
TN6205460001Medicare PIN