Healthcare Provider Details

I. General information

NPI: 1659679074
Provider Name (Legal Business Name): EYE SURGERY CENTER OF MIDDLE TENNESSEE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2011
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 25TH AVE N STE 920
NASHVILLE TN
37203-9609
US

IV. Provider business mailing address

210 25TH AVE N 920
NASHVILLE TN
37203-1606
US

V. Phone/Fax

Practice location:
  • Phone: 615-964-5912
  • Fax: 615-964-5913
Mailing address:
  • Phone: 615-620-9300
  • Fax: 615-620-9301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number0000000005
License Number StateTN

VIII. Authorized Official

Name: MR. RODNEY H LUNN SR.
Title or Position: OWNER
Credential:
Phone: 615-620-9300