Provider Demographics
NPI:1548310741
Name:TENNESSEE RIVER EYE CLINIC
Entity type:Organization
Organization Name:TENNESSEE RIVER EYE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:KASSELS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-381-2020
Mailing Address - Street 1:1110 S. MONTGOMERY AVE
Mailing Address - Street 2:HELEN KELLER HOSPITAL CAMPUS
Mailing Address - City:SHEFFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35660-6350
Mailing Address - Country:US
Mailing Address - Phone:256-381-2020
Mailing Address - Fax:256-381-7754
Practice Address - Street 1:1110 S. MONTGOMERY AVE
Practice Address - Street 2:HELEN KELLER HOSPITAL CAMPUS
Practice Address - City:SHEFFIELD
Practice Address - State:AL
Practice Address - Zip Code:35660-6350
Practice Address - Country:US
Practice Address - Phone:256-381-2020
Practice Address - Fax:256-381-7754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16162207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0810284OtherSPA
AL168150600OtherCOMMERCIAL
AL529901280Medicaid
180036556OtherRAILROAD MEDICARE
AL5567071OtherCOMMERCIAL
AL000008486AOtherBLUE CROSS
AL000008486Medicaid
261210236OtherCOMMERCIAL
AL3125128OtherCOMMERCIAL