Provider Demographics
NPI:1972773349
Name:LOW VISION CENTER, INC.
Entity type:Organization
Organization Name:LOW VISION CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:GILLILAND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:865-522-2449
Mailing Address - Street 1:1124 E WEISGARBER RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2686
Mailing Address - Country:US
Mailing Address - Phone:865-522-2449
Mailing Address - Fax:865-522-6453
Practice Address - Street 1:1124 E WEISGARBER RD
Practice Address - Street 2:SUITE 204
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2686
Practice Address - Country:US
Practice Address - Phone:865-522-2449
Practice Address - Fax:865-522-6453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-02
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1593OD152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE8160OtherRAILROAD MEDICARE
TN3943667Medicaid
TN3943667Medicare PIN