MEDICARE: TENNESSEE RIVER EYE CLINIC

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	16162	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	180036556	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0810284	OTHER	SC	SPA
2	168150600	OTHER	AL	COMMERCIAL
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	5567071	OTHER	AL	COMMERCIAL
6	000008486A	OTHER	AL	BLUE CROSS
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	261210236	OTHER		COMMERCIAL
9	3125128	OTHER	AL	COMMERCIAL

General Provider Information

NPI Number	:	1548310741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TENNESSEE RIVER EYE CLINIC

Provider Business Mailing Address
First Line	:	1110 S. MONTGOMERY AVE
Second Line	:	HELEN KELLER HOSPITAL CAMPUS
City	:	SHEFFIELD
State	:	AL
Zip	:	35660-6350
Country	:	US
Telephone Number	:	256-381-2020
Fax Number	:	256-381-7754

Provider Business Practice Location Address
First Line	:	1110 S. MONTGOMERY AVE
Second Line	:	HELEN KELLER HOSPITAL CAMPUS
City	:	SHEFFIELD
State	:	AL
Zip	:	35660-6350
Country	:	US
Telephone Number	:	256-381-2020
Fax Number	:	256-381-7754

Authorized Official
Title or Position	:	OWNER PRESIDENT
Name	:	MARK A KASSELS
Credential	:	M.D.
Telephone Number	:	256-381-2020

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	04/13/2022

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Directions to “TENNESSEE RIVER EYE CLINIC ” Practice Location

Language	Start Address	Practice Location

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