Healthcare Provider Details

I. General information

NPI: 1841351269
Provider Name (Legal Business Name): SULLINS EYE CARE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 08/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 N JACKSON ST
ATHENS TN
37303-3621
US

IV. Provider business mailing address

PO BOX 666
ATHENS TN
37371-0666
US

V. Phone/Fax

Practice location:
  • Phone: 423-745-4910
  • Fax: 423-745-2230
Mailing address:
  • Phone: 423-745-4910
  • Fax: 423-745-2230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD0000001689
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD0000001899
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberOD0000001689
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberOD0000001899
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberOD0000001722
License Number StateTN
# 6
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD0000001722
License Number StateTN

VIII. Authorized Official

Name: CHRISTA H SULLINS
Title or Position: OPTOMETRIST
Credential: OD
Phone: 423-745-4970