Provider Demographics
NPI:1407986235
Name:UNIVERSITY EYE SURGEONS, P.C.
Entity Type:Organization
Organization Name:UNIVERSITY EYE SURGEONS, P.C.
Other - Org Name:PARK WEST OPTICAL CO.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:G
Authorized Official - Last Name:RAUEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-524-9871
Mailing Address - Street 1:1928 ALCOA HWY
Mailing Address - Street 2:STE 324
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1502
Mailing Address - Country:US
Mailing Address - Phone:865-524-9871
Mailing Address - Fax:865-305-6695
Practice Address - Street 1:9349 PARK WEST BLVD STE 104
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4326
Practice Address - Country:US
Practice Address - Phone:865-690-0741
Practice Address - Fax:865-690-1218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0224460001Medicare NSC