Healthcare Provider Details

I. General information

NPI: 1568431054
Provider Name (Legal Business Name): CATARACT AND LASER CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 IRIS LN
CROSSVILLE TN
38555-7528
US

IV. Provider business mailing address

15 IRIS LN
CROSSVILLE TN
38555-7528
US

V. Phone/Fax

Practice location:
  • Phone: 931-707-0704
  • Fax: 931-707-7493
Mailing address:
  • Phone: 931-707-0704
  • Fax: 931-707-7493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number0000000130
License Number StateTN

VIII. Authorized Official

Name: JONEL PHIPPS
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 931-456-2728