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General NPI Number Information
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NPI Number | 1417120361
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Entity Type | Organization
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Legal Business Name | SPECIALEYES INC
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Dates
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Enumeration Date | 04/10/2008
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Last Update Date | 10/08/2010
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Provider Practice Location Address
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Address Line | 11232 W POINT DR SUITE A
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City | KNOXVILLE
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State | TN
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Zip | 37934-2872
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Country | US
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Telephone | 865-966-8255
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Fax | 865-966-8257
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Provider Business Mailing Address
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Address Line | 11232 W POINT DR SUITE A
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City | KNOXVILLE
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State | TN
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Zip | 37934-2872
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Country | US
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Telephone | 865-966-8255
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Fax | 865-966-8257
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Authorized Official
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Title or Position | OWNER
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Name | DR. LINA M DESAI
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Credential | O.D.
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Telephone | 865-966-8255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | ODT1971
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | ODT2234
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License Number State | TN
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