Provider Demographics
NPI:1588295307
Name:EYES ON KNOXVILLE PLLC
Entity type:Organization
Organization Name:EYES ON KNOXVILLE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KARIN
Authorized Official - Middle Name:RODRIGUEZ
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:865-405-0600
Mailing Address - Street 1:1854 STONE HARBOR WAY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-6383
Mailing Address - Country:US
Mailing Address - Phone:865-405-0600
Mailing Address - Fax:
Practice Address - Street 1:5113 CLINTON HWY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37912-3841
Practice Address - Country:US
Practice Address - Phone:864-409-2242
Practice Address - Fax:865-320-9834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3943794Medicaid