Organization Active NPI

Tullahoma Vision Associates P C

  • Optometrist
  • Tullahoma, TN
National Provider Identifier
1598808909
Registry record updated Mar 20, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
TULLAHOMA VISION ASSOCIATES P C
Practice address
105 W Blackwell St
Tullahoma, TN 37388-3555
Phone
(931) 455-0654
Fax
(931) 455-0669
NPI assigned
Feb 15, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
James Shawn McBride, O.D.NPI 1700856267
Title
President
Phone
(931) 455-0654

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

105 W Blackwell St
Tullahoma, TN 37388-3555

Mailing address

105 W Blackwell St
Tullahoma, TN 37388-3555
Phone (931) 455-0654

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20090406000657 TN Part B Supplier - Clinic/Group Practice 5799832879 Receives reassigned benefits from 2 practitioners
Practice locations: Tullahoma, TN
O20100930028516 TN DME Supplier - Physician - OptometristDME Supplier - Optician 5799832879 Practice locations: Tullahoma, TN

National Provider Directory

National Provider Directory

Locations

600 Airpark Dr
Tullahoma, TN 37388
Phone (931) 455-0654

105 W Blackwell St
Tullahoma, TN 37388
Phone (931) 455-0654

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237507200000",
    "number": "1598808909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 W BLACKWELL ST",
            "city": "TULLAHOMA",
            "state": "TN",
            "postal_code": "373883555",
            "telephone_number": "931-455-0654",
            "fax_number": "931-455-0669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 W BLACKWELL ST",
            "city": "TULLAHOMA",
            "state": "TN",
            "postal_code": "373883555",
            "telephone_number": "931-455-0654",
            "fax_number": "931-455-0669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TULLAHOMA VISION ASSOCIATES P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-15",
        "last_updated": "2009-03-20",
        "status": "A",
        "authorized_official_last_name": "MCBRIDE",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "SHAWN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "931-455-0654",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tullahoma, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.