Provider Demographics
NPI:1114376977
Name:PEPELEA FAMILY EYE CARE PLLC
Entity Type:Organization
Organization Name:PEPELEA FAMILY EYE CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALISSA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:PEPELEA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:317-289-3189
Mailing Address - Street 1:1910 MOSAIC TRL
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-9021
Mailing Address - Country:US
Mailing Address - Phone:615-904-9460
Mailing Address - Fax:615-895-4280
Practice Address - Street 1:125 JOHN R RICE BLVD
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-4165
Practice Address - Country:US
Practice Address - Phone:615-904-9460
Practice Address - Fax:615-895-4280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-11
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2866152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty