Provider Demographics
NPI:1336135847
Name:MORRISTOWN REGIONAL EYE CENTER
Entity Type:Organization
Organization Name:MORRISTOWN REGIONAL EYE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:H
Authorized Official - Last Name:LINDSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-581-0360
Mailing Address - Street 1:3001 W ANDREW JOHNSON HWY
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-3614
Mailing Address - Country:US
Mailing Address - Phone:423-581-0360
Mailing Address - Fax:423-317-6581
Practice Address - Street 1:3001 W ANDREW JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3614
Practice Address - Country:US
Practice Address - Phone:423-581-0360
Practice Address - Fax:423-317-6581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3379677Medicaid
3379677Medicare ID - Type Unspecified