Healthcare Provider Details

I. General information

NPI: 1508927971
Provider Name (Legal Business Name): TARR EYE & VISION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 W HIGHWAY 11E
NEW MARKET TN
37820-4305
US

IV. Provider business mailing address

PO BOX 766
JEFFERSON CITY TN
37760-0766
US

V. Phone/Fax

Practice location:
  • Phone: 865-475-6565
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2482
License Number StateTN

VIII. Authorized Official

Name: DR. BLAKE W. TARR
Title or Position: OWNER
Credential: O.D.
Phone: 865-475-6565