Healthcare Provider Details

I. General information

NPI: 1831128768
Provider Name (Legal Business Name): EYE CARE GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 AMANDA AVE
DYERSBURG TN
38024-1961
US

IV. Provider business mailing address

PO BOX 509
HUMBOLDT TN
38343-0509
US

V. Phone/Fax

Practice location:
  • Phone: 731-286-1002
  • Fax: 731-286-6231
Mailing address:
  • Phone: 731-784-1186
  • Fax: 731-784-8228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. PHILLIP EARL AGEE
Title or Position: CHIEF MANAGER
Credential: O D
Phone: 731-784-1186