Provider Demographics
NPI:1487795647
Name:HALF PRICE OPTICAL, INC.
Entity type:Organization
Organization Name:HALF PRICE OPTICAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GENIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-894-2484
Mailing Address - Street 1:5506 BRAINERD RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-5338
Mailing Address - Country:US
Mailing Address - Phone:423-894-2484
Mailing Address - Fax:423-894-2561
Practice Address - Street 1:5506 BRAINERD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-5338
Practice Address - Country:US
Practice Address - Phone:423-894-2484
Practice Address - Fax:423-894-2561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1012332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0691420001Medicare ID - Type UnspecifiedOPTICAL