Provider Demographics
NPI:1861788606
Name:TOTAL EYECARE OF EAST TN CORP
Entity type:Organization
Organization Name:TOTAL EYECARE OF EAST TN CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:865-609-1160
Mailing Address - Street 1:7420 CHAPMAN HWY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-6614
Mailing Address - Country:US
Mailing Address - Phone:865-609-1160
Mailing Address - Fax:865-609-1157
Practice Address - Street 1:7420 CHAPMAN HWY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-6614
Practice Address - Country:US
Practice Address - Phone:865-609-1160
Practice Address - Fax:865-609-1157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-20
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2935152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103G701856Medicare PIN