Provider Demographics
NPI:1235163379
Name:EAST RIDGE EYE CENTER, PC
Entity Type:Organization
Organization Name:EAST RIDGE EYE CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PIERCE
Authorized Official - Last Name:RICHMOND
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:423-894-1453
Mailing Address - Street 1:932 SPRING CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37412-3910
Mailing Address - Country:US
Mailing Address - Phone:423-894-1453
Mailing Address - Fax:423-899-8022
Practice Address - Street 1:932 SPRING CREEK RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37412-3910
Practice Address - Country:US
Practice Address - Phone:423-894-1453
Practice Address - Fax:423-899-8022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0000058Medicaid
TNDE3063OtherRAILROAD MEDICARE
TN0663970001Medicare NSC
TN0000058Medicaid