Provider Demographics
NPI:1548302854
Name:DONELSON EYECARE, PLLC
Entity type:Organization
Organization Name:DONELSON EYECARE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KEGARISE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:615-771-7555
Mailing Address - Street 1:3252 ASPEN GROVE DR STE 1
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-4894
Mailing Address - Country:US
Mailing Address - Phone:615-786-9044
Mailing Address - Fax:615-905-4655
Practice Address - Street 1:2378 LEBANON PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-2411
Practice Address - Country:US
Practice Address - Phone:615-889-0147
Practice Address - Fax:615-889-2700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X, 152WC0802X, 332H00000X
TN1459152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1532322Medicaid
TN1020400001Medicare NSC
TN3944059Medicare PIN