Provider Demographics
NPI:1548013832
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:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:DEANNE
Authorized Official - Last Name:BREEDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-456-2728
Mailing Address - Street 1:430 NEAL ST
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-0916
Mailing Address - Country:US
Mailing Address - Phone:931-528-6411
Mailing Address - Fax:
Practice Address - Street 1:430 NEAL ST
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-0916
Practice Address - Country:US
Practice Address - Phone:931-528-6411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYE CENTERS OF TENNESSEE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty