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General NPI Number Information
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NPI Number | 1831128768
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Entity Type | Organization
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Legal Business Name | EYE CARE GROUP, PLLC
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Dates
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Enumeration Date | 07/02/2006
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Last Update Date | 05/15/2008
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Provider Practice Location Address
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Address Line | 2300 AMANDA AVE
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City | DYERSBURG
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State | TN
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Zip | 38024-1961
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Country | US
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Telephone | 731-286-1002
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Fax | 731-286-6231
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Provider Business Mailing Address
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Address Line | PO BOX 509
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City | HUMBOLDT
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State | TN
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Zip | 38343-0509
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Country | US
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Telephone | 731-784-1186
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Fax | 731-784-8228
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Authorized Official
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Title or Position | CHIEF MANAGER
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Name | DR. PHILLIP EARL AGEE
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Credential | O D
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Telephone | 731-784-1186
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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 |
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License Number State |
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