Provider Demographics
NPI:1356689913
Name:TENNESSEE EYE ASSOCIATED, LLC
Entity Type:Organization
Organization Name:TENNESSEE EYE ASSOCIATED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:615-788-9775
Mailing Address - Street 1:PO BOX 581
Mailing Address - Street 2:
Mailing Address - City:NOLENSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37135
Mailing Address - Country:US
Mailing Address - Phone:615-788-9775
Mailing Address - Fax:615-534-2178
Practice Address - Street 1:803 INDUSTRIAL BOULEVARD
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167
Practice Address - Country:US
Practice Address - Phone:615-459-6083
Practice Address - Fax:615-534-2178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2921152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty