Healthcare Provider Details

I. General information

NPI: 1285860437
Provider Name (Legal Business Name): BILLINGSLEY EYE CARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2009
Last Update Date: 06/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 TURNER ST
MARYVILLE TN
37801-3595
US

IV. Provider business mailing address

845 TURNER ST
MARYVILLE TN
37801-3595
US

V. Phone/Fax

Practice location:
  • Phone: 865-681-3937
  • Fax:
Mailing address:
  • Phone: 865-681-3937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberODT 1436
License Number StateTN

VIII. Authorized Official

Name: DR. SHARON M. BILLINGSLEY
Title or Position: OWNER
Credential: O.D.
Phone: 865-681-3937