Healthcare Provider Details

I. General information

NPI: 1952635690
Provider Name (Legal Business Name): ANDERSON EYE CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2009
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1642 MCARTHUR ST
MANCHESTER TN
37355-2522
US

IV. Provider business mailing address

1642 MCARTHUR ST
MANCHESTER TN
37355-2522
US

V. Phone/Fax

Practice location:
  • Phone: 931-728-1315
  • Fax: 931-728-1779
Mailing address:
  • Phone: 931-728-1315
  • Fax: 931-728-1779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JEREMY ANDERSON
Title or Position: OWNER
Credential: O.D.
Phone: 931-728-1315