Provider Demographics
NPI:1033254289
Name:COOKEVILLE EYE SPECIALISTS, PLLC
Entity Type:Organization
Organization Name:COOKEVILLE EYE SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-528-1304
Mailing Address - Street 1:1125 PERIMETER PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-0912
Mailing Address - Country:US
Mailing Address - Phone:931-528-1304
Mailing Address - Fax:931-372-8958
Practice Address - Street 1:1125 PERIMETER PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-0912
Practice Address - Country:US
Practice Address - Phone:931-528-1304
Practice Address - Fax:931-372-8958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNT1567152W00000X
TNMD024999207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3372050Medicare ID - Type Unspecified