MEDICARE: UNIVERSITY EYE SURGEONS, P.C.

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	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1407986235
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY EYE SURGEONS, P.C.

Provider Business Mailing Address
First Line	:	1928 ALCOA HWY
Second Line	:	STE 324
City	:	KNOXVILLE
State	:	TN
Zip	:	37920-1502
Country	:	US
Telephone Number	:	865-524-9871
Fax Number	:	865-305-6695

Provider Business Practice Location Address
First Line	:	9349 PARK WEST BLVD STE 104
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37923-4326
Country	:	US
Telephone Number	:	865-690-0741
Fax Number	:	865-690-1218

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	LARRY G RAUEN
Credential	:
Telephone Number	:	865-524-9871

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	02/06/2013

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