Provider Demographics
NPI:1306014378
Name:EYE CENTERS OF TENNESSEE, LLC
Entity Type:Organization
Organization Name:EYE CENTERS OF TENNESSEE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRONT OFFICE CREDENTIALING
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BREEDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-456-2728
Mailing Address - Street 1:15 IRIS LN
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-7528
Mailing Address - Country:US
Mailing Address - Phone:931-456-2728
Mailing Address - Fax:931-456-5446
Practice Address - Street 1:220 N CHANCERY ST
Practice Address - Street 2:
Practice Address - City:MC MINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-2551
Practice Address - Country:US
Practice Address - Phone:931-473-2487
Practice Address - Fax:931-473-8782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD3109152W00000X
TNMD16334207W00000X
TNMD9365332B00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ008842Medicaid
TN3724242Medicare PIN
TN3943261Medicare PIN