Provider Demographics
NPI:1326217647
Name:KNOXVILLE EYE SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:KNOXVILLE EYE SURGERY CENTER, LLC
Other - Org Name:TENNESSEE VALLEY OPTICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:RAUEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-544-6912
Mailing Address - Street 1:140 CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3343
Mailing Address - Country:US
Mailing Address - Phone:865-251-0340
Mailing Address - Fax:865-251-0330
Practice Address - Street 1:140 CAPITOL DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3343
Practice Address - Country:US
Practice Address - Phone:865-251-0340
Practice Address - Fax:865-251-0330
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KNOXVILLE EYE SURGERY CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPO980332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier