Provider Demographics
NPI:1902920507
Name:EYE CENTERS OF TENNESSEE, LLC
Entity Type:Organization
Organization Name:EYE CENTERS OF TENNESSEE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRONT OFFICE CREDENTIALING
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BREEDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-456-2728
Mailing Address - Street 1:15 IRIS LN
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-7528
Mailing Address - Country:US
Mailing Address - Phone:931-456-2728
Mailing Address - Fax:931-456-5446
Practice Address - Street 1:768 S WILLOW AVE STE A
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-3892
Practice Address - Country:US
Practice Address - Phone:931-528-1567
Practice Address - Fax:931-528-6094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X, 156FX1800X, 207W00000X
TNOD723332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3724246Medicaid
TNA98164Medicare UPIN
TNT61193Medicare UPIN
TNT61219Medicare UPIN
TNH30468Medicare UPIN
TNA99553Medicare UPIN
TNT61230Medicare UPIN
TN3943261Medicaid
TN3724247Medicare PIN
TN3724246Medicare PIN