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General NPI Number Information
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NPI Number | 1578807269
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Entity Type | Organization
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Legal Business Name | FIVE RIVERS EYECARE PLLC
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Dates
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Enumeration Date | 11/19/2012
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Last Update Date | 12/20/2021
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Provider Practice Location Address
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Address Line | 1411 W MORRIS BLVD
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City | MORRISTOWN
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State | TN
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Zip | 37813-2828
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Country | US
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Telephone | 423-587-3474
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Fax |
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Provider Business Mailing Address
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Address Line | 115 HEDRICK DRIVE
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City | NEWPORT
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State | TN
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Zip | 37821
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Country | US
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Telephone | 423-623-2020
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Fax | 423-623-3937
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Authorized Official
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Title or Position | OD/OWNER
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Name | MR. JAMES YANDELL
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Credential | OD
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Telephone | 423-623-2020
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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 | TN
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