Organization
LIGHTHOUSE OPTICAL OF TENNESSEE, LLC
Active
Other names
Horner Rausch Super Optical Of Cookeville
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN MORGAN RICHARDSON O.D. (OPTOMETRIST/OWNER)
(931) 528-6411
Entity
Organization
Contact information
Practice address
430 NEAL ST, COOKEVILLE, TN 38501-0916
(931) 528-6411
(931) 372-0380
Mailing address
430 NEAL ST, COOKEVILLE, TN 38501-0916
(931) 528-6411
(931) 372-0380
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD T-1155
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3087067
BLUE CROSS BLUE SHIELD TN
TN
05
—
3596618
—
TN
01
—
3945214
GROUP PROVIDER NUMBER
TN
Enumeration date
07/26/2007
Last updated
04/05/2023
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