Provider Demographics
NPI:1114179587
Name:SKYLINE EYE CLINIC, PC
Entity Type:Organization
Organization Name:SKYLINE EYE CLINIC, PC
Other - Org Name:EYE CLINIC, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:J
Authorized Official - Last Name:KEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-424-2414
Mailing Address - Street 1:138 HOUSTON AVE
Mailing Address - Street 2:
Mailing Address - City:SELMER
Mailing Address - State:TN
Mailing Address - Zip Code:38375-2127
Mailing Address - Country:US
Mailing Address - Phone:731-645-7255
Mailing Address - Fax:
Practice Address - Street 1:138 HOUSTON AVE
Practice Address - Street 2:
Practice Address - City:SELMER
Practice Address - State:TN
Practice Address - Zip Code:38375-2127
Practice Address - Country:US
Practice Address - Phone:731-645-7255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN457152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty