Provider Demographics
NPI:1053580878
Name:BORDASH FAMILY EYE CENTER LLC
Entity type:Organization
Organization Name:BORDASH FAMILY EYE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:BORDASH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:423-899-8626
Mailing Address - Street 1:2100 HAMILTON PLACE BLVD STE 280
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-6030
Mailing Address - Country:US
Mailing Address - Phone:423-899-8626
Mailing Address - Fax:423-855-0044
Practice Address - Street 1:2100 HAMILTON PLACE BLVD STE 280
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421
Practice Address - Country:US
Practice Address - Phone:423-899-8626
Practice Address - Fax:423-855-0044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1693152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4096541OtherBCBS
TN4096541OtherBCBS
TN3728129Medicare PIN