Provider Demographics
NPI:1255860383
Name:EYE SURGERY CENTER OF KNOXVILLE, LLC
Entity Type:Organization
Organization Name:EYE SURGERY CENTER OF KNOXVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:RUDOLPH
Authorized Official - Suffix:SR
Authorized Official - Credentials:CPA
Authorized Official - Phone:865-339-4200
Mailing Address - Street 1:448 N CEDAR BLUFF RD STE 255
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-3612
Mailing Address - Country:US
Mailing Address - Phone:865-339-4200
Mailing Address - Fax:865-362-5532
Practice Address - Street 1:7739 DANNAHER DRIVE
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849
Practice Address - Country:US
Practice Address - Phone:865-339-4200
Practice Address - Fax:865-362-5532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-12
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical