Provider Demographics
NPI:1326508045
Name:EYE SURGERY CENTER OF LENOIR CITY, LLC
Entity Type:Organization
Organization Name:EYE SURGERY CENTER OF LENOIR CITY, 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:865-328-7400
Mailing Address - Street 1:5491 CREEKWOOD PARK BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772-1204
Mailing Address - Country:US
Mailing Address - Phone:865-635-4545
Mailing Address - Fax:865-317-1270
Practice Address - Street 1:5491 CREEKWOOD PARK BLVD STE B
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-1204
Practice Address - Country:US
Practice Address - Phone:865-328-7400
Practice Address - Fax:865-317-1270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-20
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical