Provider Demographics
NPI:1154509586
Name:LEBANON EYE ASSOC, PC
Entity Type:Organization
Organization Name:LEBANON EYE ASSOC, PC
Other - Org Name:THE EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:RAGSDALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-453-5155
Mailing Address - Street 1:1670 W MAIN ST
Mailing Address - Street 2:STE 100
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-1344
Mailing Address - Country:US
Mailing Address - Phone:615-453-5155
Mailing Address - Fax:615-444-5915
Practice Address - Street 1:300 STONECREST BLVD
Practice Address - Street 2:STE 340
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-5688
Practice Address - Country:US
Practice Address - Phone:615-453-5155
Practice Address - Fax:615-444-5915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16211207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3389788Medicaid
TN3389788Medicare PIN