=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104968817
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COOL SPRINGS EYECARE, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2007
-----------------------------------------------------
Last Update Date | 05/08/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3252 ASPEN GROVE DRIVE SUITE 1
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37067-7215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-771-7555
-----------------------------------------------------
Fax | 615-771-7773
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3252 ASPEN GROVE DRIVE SUITE 1
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37067-7215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-771-7555
-----------------------------------------------------
Fax | 615-771-7773
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JEFFREY KEGARISE
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 615-771-7555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 152W00000X
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------