MEDICARE: LEBANON EYE ASSOCIATES PC

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
1	207W00000X	Ophthalmology Physician	16211	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CL3416	OTHER	TN	PALMETTO-GBA MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1238610001	OTHER	TN	DMERC SUPPLIER-OPTHALMOLO
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528194305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEBANON EYE ASSOCIATES PC

Provider Business Mailing Address
First Line	:	1670 W MAIN ST
Second Line	:	SUITE 100
City	:	LEBANON
State	:	TN
Zip	:	37087-1344
Country	:	US
Telephone Number	:	615-453-5155
Fax Number	:	615-444-5915

Provider Business Practice Location Address
First Line	:	1670 W MAIN ST
Second Line	:	SUITE 100
City	:	LEBANON
State	:	TN
Zip	:	37087-1344
Country	:	US
Telephone Number	:	615-453-5155
Fax Number	:	615-444-5915

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. KIMBERLY A FRANKS
Credential	:
Telephone Number	:	615-453-5155

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	11/20/2007

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