Provider Demographics
NPI:1033305735
Name:MIDDLE TENNESSEE EYE ASSOCIATES OF COOKEVILLE PLLC
Entity Type:Organization
Organization Name:MIDDLE TENNESSEE EYE ASSOCIATES OF COOKEVILLE PLLC
Other - Org Name:MIDDLE TENNESSEE EYE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISSA
Authorized Official - Middle Name:CRAFT
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-372-1994
Mailing Address - Street 1:600 E VETERANS DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-4038
Mailing Address - Country:US
Mailing Address - Phone:931-372-1994
Mailing Address - Fax:931-372-9045
Practice Address - Street 1:600 E VETERANS DR
Practice Address - Street 2:SUITE A
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-4038
Practice Address - Country:US
Practice Address - Phone:931-372-1994
Practice Address - Fax:931-372-9045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000040781207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6046830001Medicare NSC