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General NPI Number Information
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NPI Number | 1154112977
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Entity Type | Organization
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Legal Business Name | LIBERTY EYE CARE LLC
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Dates
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Enumeration Date | 05/13/2025
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 1815 DECATUR PIKE
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City | ATHENS
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State | TN
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Zip | 37303-4932
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Country | US
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Telephone | 423-745-5100
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Fax | 423-815-1554
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Provider Business Mailing Address
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Address Line | 1815 DECATUR PIKE
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City | ATHENS
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State | TN
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Zip | 37303-4932
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Country | US
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Telephone | 423-745-5100
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Fax | 423-815-1554
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Authorized Official
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Title or Position | OWNER
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Name | DR. ERIC SELANDER
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Credential | OD
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Telephone | 423-745-5100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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