Provider Demographics
NPI:1144482753
Name:CLARKSVILLE EYE SURGERY CENTER
Entity type:Organization
Organization Name:CLARKSVILLE EYE SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:C
Authorized Official - Middle Name:P
Authorized Official - Last Name:FITCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-245-1940
Mailing Address - Street 1:141 CHESAPEAKE LANE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-5243
Mailing Address - Country:US
Mailing Address - Phone:931-245-1940
Mailing Address - Fax:931-245-1982
Practice Address - Street 1:141 CHESAPEAKE LANE
Practice Address - Street 2:STE 200
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-5243
Practice Address - Country:US
Practice Address - Phone:931-245-1940
Practice Address - Fax:931-245-1982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
TN261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty