MEDICARE: SKYLINE EYE CLINIC, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1154328813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKYLINE EYE CLINIC, PC

Provider Business Mailing Address
First Line	:	668 SKYLINE DR
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38301-3951
Country	:	US
Telephone Number	:	731-424-2414
Fax Number	:	731-424-4444

Provider Business Practice Location Address
First Line	:	668 SKYLINE DR
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38301-3951
Country	:	US
Telephone Number	:	731-424-2414
Fax Number	:	731-424-4444

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. RAYMOND JAMES KEE
Credential	:
Telephone Number	:	731-424-2414

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	08/22/2020

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