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General NPI Number Information
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NPI Number | 1578773263
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Entity Type | Organization
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Legal Business Name | COMPLETE EYE CARE, PC
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 01/20/2015
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Provider Practice Location Address
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Address Line | 9453 DAYTON PIKE
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City | SODDY DAISY
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State | TN
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Zip | 37379-4751
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Country | US
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Telephone | 423-332-8222
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Fax | 423-332-8278
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Provider Business Mailing Address
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Address Line | 9453 DAYTON PIKE
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City | SODDY DAISY
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State | TN
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Zip | 37379-4751
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Country | US
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Telephone | 423-332-8222
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Fax | 423-332-8278
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN D. BONNER
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Credential | M.D.
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Telephone | 423-332-8222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 28919
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD0000028919
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License Number State | TN
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