MEDICARE: THE REGIONAL EYE CENTER, P.C.

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

General Provider Information

NPI Number	:	1811040751
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE REGIONAL EYE CENTER, P.C.

Provider Business Mailing Address
First Line	:	135 W RAVINE RD
Second Line	:	SUITE 2C
City	:	KINGSPORT
State	:	TN
Zip	:	37660-3847
Country	:	US
Telephone Number	:	423-246-7372
Fax Number	:	423-578-4369

Provider Business Practice Location Address
First Line	:	4 SHERIDAN SQ
Second Line	:	SUITE 102
City	:	KINGSPORT
State	:	TN
Zip	:	37660-7435
Country	:	US
Telephone Number	:	423-246-8196
Fax Number	:	423-246-2308

Authorized Official
Title or Position	:	CEO
Name	:	JOHN T WILLIAMS
Credential	:
Telephone Number	:	423-246-7372

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	05/29/2008

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