MEDICARE: CORNEA CONSULTANTS OF NASHVILLE, PLLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4098044	OTHER	TN	BCBS

General Provider Information

NPI Number	:	1588744767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORNEA CONSULTANTS OF NASHVILLE, PLLC

Provider Business Mailing Address
First Line	:	335 24TH AVE N STE 600
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-1503
Country	:	US
Telephone Number	:	615-320-7200
Fax Number	:	615-320-7203

Provider Business Practice Location Address
First Line	:	335 24TH AVE N STE 600
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-1503
Country	:	US
Telephone Number	:	708-670-8173
Fax Number	:	615-320-7203

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. IRA A SHIVITZ
Credential	:	MD
Telephone Number	:	615-320-7200

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	12/19/2024

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