Healthcare Provider Details

I. General information

NPI: 1609868363
Provider Name (Legal Business Name): CAMDEN EYE CARE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 08/27/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 HIGHWAY 641 N
CAMDEN TN
38320-1329
US

IV. Provider business mailing address

264 HIGHWAY 641 N
CAMDEN TN
38320-1329
US

V. Phone/Fax

Practice location:
  • Phone: 731-584-7942
  • Fax: 731-584-7965
Mailing address:
  • Phone: 731-584-7942
  • Fax: 731-584-7965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD0000002255
License Number StateTN

VIII. Authorized Official

Name: DR. TONYA M REYNOLDSON
Title or Position: OPTOMETRIST
Credential: OD
Phone: 731-584-7942