Healthcare Provider Details

I. General information

NPI: 1356689913
Provider Name (Legal Business Name): TENNESSEE EYE ASSOCIATED, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2013
Last Update Date: 01/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 INDUSTRIAL BOULEVARD
SMYRNA TN
37167
US

IV. Provider business mailing address

PO BOX 581
NOLENSVILLE TN
37135
US

V. Phone/Fax

Practice location:
  • Phone: 615-459-6083
  • Fax: 615-534-2178
Mailing address:
  • Phone: 615-788-9775
  • Fax: 615-534-2178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2921
License Number StateTN

VIII. Authorized Official

Name: DR. PHILLIP DANIEL HAYES
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 615-788-9775