=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720433303
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTER FOR SIGHT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2016
-----------------------------------------------------
Last Update Date | 02/21/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7800 CONNER RD
-----------------------------------------------------
City | POWELL
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37849-3511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-546-7140
-----------------------------------------------------
Fax | 865-546-8048
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7800 CONNER RD
-----------------------------------------------------
City | POWELL
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37849-3511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-546-7140
-----------------------------------------------------
Fax | 865-546-8048
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | JENNIFER TWEED
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 865-546-7140
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 0282262
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------