Provider Demographics
NPI:1962529354
Name:LITCHFORD EYE CLINIC, PC
Entity type:Organization
Organization Name:LITCHFORD EYE CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:LITCHFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-484-9547
Mailing Address - Street 1:33 W ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-4836
Mailing Address - Country:US
Mailing Address - Phone:931-484-9547
Mailing Address - Fax:931-484-9547
Practice Address - Street 1:33 W ADAMS ST
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-4836
Practice Address - Country:US
Practice Address - Phone:931-484-9547
Practice Address - Fax:931-484-9547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD7983174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2000639OtherBCBS
TN33797017Medicaid
TNCM6292OtherRR MEDICARE
TNB02923Medicare UPIN
TN3379017Medicare ID - Type Unspecified