Provider Demographics
NPI:1003156878
Name:ROBERT REMKE OPTOMETRY, PLLC
Entity Type:Organization
Organization Name:ROBERT REMKE OPTOMETRY, PLLC
Other - Org Name:ROBERT REMKE EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRELLA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:CPC,CEMC
Authorized Official - Phone:931-762-7226
Mailing Address - Street 1:726 N LOCUST AVE
Mailing Address - Street 2:2ND FLOOR SUITE D
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-2802
Mailing Address - Country:US
Mailing Address - Phone:931-762-7226
Mailing Address - Fax:931-762-5888
Practice Address - Street 1:726 N LOCUST AVE
Practice Address - Street 2:2ND FLOOR SUITE D
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-2802
Practice Address - Country:US
Practice Address - Phone:931-762-7226
Practice Address - Fax:931-762-5888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD1171152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3596506Medicaid