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NPI Code Detail

MEDICARE: EYE CENTERS OF TENNESSEE, LLC

MEDICARE: EYE CENTERS OF TENNESSEE, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist
2156FX1800XOptician
3332B00000XDurable Medical Equipment & Medical SuppliesMD16334TN
4207W00000XOphthalmology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
23144522OTHERTNBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1104940790
Entity Type Code : Organization
Provider Name (Legal Business Name) : EYE CENTERS OF TENNESSEE, LLC
Provider Business Mailing Address
First Line : 15 IRIS LN
Second Line :
City : CROSSVILLE
State : TN
Zip : 38555-7528
Country : US
Telephone Number : 931-456-2728
Fax Number : 931-456-5446
Provider Business Practice Location Address
First Line : 15 IRIS LN
Second Line :
City : CROSSVILLE
State : TN
Zip : 38555-7528
Country : US
Telephone Number : 931-456-2728
Fax Number : 931-456-5446
Authorized Official
Title or Position : ADMINISTRATOR
Name : MR. RAYMOND K MAYS
Credential :
Telephone Number : 931-456-2728
Provider Enumeration Date : 03/19/2007
Last Update Date : 04/26/2021

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Directions to “EYE CENTERS OF TENNESSEE, LLC ” Practice Location

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