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NPI Code Detail

MEDICARE: EYE SURGERY CENTER OF LENOIR CITY, LLC

MEDICARE: EYE SURGERY CENTER OF LENOIR CITY, 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
1261QA1903XAmbulatory Surgical Clinic/Center

General Provider Information

NPI Number : 1326508045
Entity Type Code : Organization
Provider Name (Legal Business Name) : EYE SURGERY CENTER OF LENOIR CITY, LLC
Provider Business Mailing Address
First Line : 5491 CREEKWOOD PARK BLVD STE B
Second Line :
City : LENOIR CITY
State : TN
Zip : 37772-1204
Country : US
Telephone Number : 865-635-4545
Fax Number : 865-317-1270
Provider Business Practice Location Address
First Line : 5491 CREEKWOOD PARK BLVD STE B
Second Line :
City : LENOIR CITY
State : TN
Zip : 37772-1204
Country : US
Telephone Number : 865-328-7400
Fax Number : 865-317-1270
Authorized Official
Title or Position : CHIEF OPERATING OFFICER
Name : MR. STEPHEN H RUDOLPH SR.
Credential : CPA
Telephone Number : 865-328-7400
Provider Enumeration Date : 03/20/2019
Last Update Date : 07/23/2021

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Directions to “EYE SURGERY CENTER OF LENOIR CITY, LLC ” Practice Location

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