Healthcare Provider Details

I. General information

NPI: 1699961631
Provider Name (Legal Business Name): BLOUNT COUNTY EYE CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1732 W BROADWAY AVE
MARYVILLE TN
37801-5510
US

IV. Provider business mailing address

702 S FOOTHILLS PLAZA DR
MARYVILLE TN
37801-2300
US

V. Phone/Fax

Practice location:
  • Phone: 865-982-6761
  • Fax: 865-982-7402
Mailing address:
  • Phone: 865-982-6761
  • Fax: 865-982-7402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberODT694
License Number StateTN

VIII. Authorized Official

Name: ROBERT B DUVALL
Title or Position: MANAGER
Credential: OD
Phone: 865-982-6761