Healthcare Provider Details

I. General information

NPI: 1932224128
Provider Name (Legal Business Name): EYE CENTERS OF TENNESSEE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 OLD HWY 127 SOUTH
JAMESTOWN TN
38556
US

IV. Provider business mailing address

15 IRIS LN
CROSSVILLE TN
38555-7528
US

V. Phone/Fax

Practice location:
  • Phone: 931-879-5897
  • Fax: 931-879-8166
Mailing address:
  • Phone: 931-456-2728
  • Fax: 931-456-5446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberOD729
License Number StateTN

VIII. Authorized Official

Name: MRS. TINA D BREEDING
Title or Position: OFFICE MANAGER
Credential:
Phone: 931-456-2728