Provider Demographics
NPI:1326503699
Name:TENNESSEE EYE CARE SPECIALISTS, PLLC
Entity Type:Organization
Organization Name:TENNESSEE EYE CARE SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:W
Authorized Official - Last Name:JOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-500-4667
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:901-219-0173
Mailing Address - Fax:
Practice Address - Street 1:902 W MADISON AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-3432
Practice Address - Country:US
Practice Address - Phone:800-500-4667
Practice Address - Fax:865-295-0167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-31
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty