Healthcare Provider Details

I. General information

NPI: 1154112977
Provider Name (Legal Business Name): LIBERTY EYE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 DECATUR PIKE
ATHENS TN
37303-4932
US

IV. Provider business mailing address

1815 DECATUR PIKE
ATHENS TN
37303-4932
US

V. Phone/Fax

Practice location:
  • Phone: 423-745-5100
  • Fax: 423-815-1554
Mailing address:
  • Phone: 423-745-5100
  • Fax: 423-815-1554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIC SELANDER
Title or Position: OWNER
Credential: OD
Phone: 423-745-5100