Provider Demographics
NPI:1225060718
Name:MIDDLE TENNESSEE EYE ASSOCIATES, PLC
Entity Type:Organization
Organization Name:MIDDLE TENNESSEE EYE ASSOCIATES, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPHTHALMOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:COLBY
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-966-9182
Mailing Address - Street 1:9815 COGDILL RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37932-3375
Mailing Address - Country:US
Mailing Address - Phone:865-966-9182
Mailing Address - Fax:865-966-9185
Practice Address - Street 1:9815 COGDILL RD
Practice Address - Street 2:SUITE 3
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37932-3375
Practice Address - Country:US
Practice Address - Phone:865-966-9182
Practice Address - Fax:865-966-9185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD0000002499152W00000X
TNMD0000028149207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3945728Medicare ID - Type Unspecified
TN4772060001Medicare NSC
TN3711309Medicare ID - Type Unspecified