Provider Demographics
NPI:1114190535
Name:GREENEVILLE EYE CLINIC
Entity Type:Organization
Organization Name:GREENEVILLE EYE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-639-6848
Mailing Address - Street 1:1406 TUSCULUM BLVD
Mailing Address - Street 2:MOB 2, SUITE 1000
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-4332
Mailing Address - Country:US
Mailing Address - Phone:423-639-6848
Mailing Address - Fax:423-787-7210
Practice Address - Street 1:1406 TUSCULUM BLVD
Practice Address - Street 2:MOB 2, SUITE 1000
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-4332
Practice Address - Country:US
Practice Address - Phone:423-639-6848
Practice Address - Fax:423-787-7210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-07
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3370294Medicaid
TN3370294Medicaid