Provider Demographics
NPI:1275702045
Name:CLAYTON B RHODES OD PC
Entity Type:Organization
Organization Name:CLAYTON B RHODES OD PC
Other - Org Name:HIXSON EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:WRIGHT
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:
Authorized Official - Credentials:NA
Authorized Official - Phone:423-314-6631
Mailing Address - Street 1:5433 HIXSON PIKE
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-3238
Mailing Address - Country:US
Mailing Address - Phone:423-843-2020
Mailing Address - Fax:423-842-1914
Practice Address - Street 1:5433 HIXSON PIKE
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-3238
Practice Address - Country:US
Practice Address - Phone:423-843-2020
Practice Address - Fax:423-842-1914
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLAYTON B RHODES OD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-26
Last Update Date:2021-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD507152W00000X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2008500OtherBLUE CROSS & BLUE SHIELD
TNU01194Medicare UPIN
TN3593471Medicare PIN
TN0400520001Medicare NSC