Provider Demographics
NPI:1154328813
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
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:KEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-424-2414
Mailing Address - Street 1:668 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-3951
Mailing Address - Country:US
Mailing Address - Phone:731-424-2414
Mailing Address - Fax:731-424-4444
Practice Address - Street 1:668 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3951
Practice Address - Country:US
Practice Address - Phone:731-424-2414
Practice Address - Fax:731-424-4444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU01215Medicare UPIN
TNG89664Medicare UPIN
TNF83022Medicare UPIN
TNG42148Medicare UPIN
TNB02309Medicare UPIN
TNB02650Medicare UPIN
TNB02917Medicare UPIN