MEDICARE: MYEYEDR OPTOMETRY OF TENNESSEE, LLC

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	152W00000X	Optometrist

General Provider Information

NPI Number	:	1588516918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MYEYEDR OPTOMETRY OF TENNESSEE, LLC

Provider Business Mailing Address
First Line	:	8614 WESTWOOD CENTER DR FL 9
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22182-2442
Country	:	US
Telephone Number	:	703-847-8899
Fax Number	:	571-223-6780

Provider Business Practice Location Address
First Line	:	1917 N MOUNT JULIET RD STE 103
Second Line	:
City	:	MT JULIET
State	:	TN
Zip	:	37122-4688
Country	:	US
Telephone Number	:	615-523-2487
Fax Number	:	615-523-2487

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	SUE ANN DOWNES
Credential	:
Telephone Number	:	785-492-5871

Provider Enumeration Date	:	02/10/2026
Last Update Date	:	02/10/2026

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