Provider Demographics
NPI:1447599659
Name:SOUTHEAST EYE SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:SOUTHEAST EYE SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-966-7337
Mailing Address - Street 1:1400 DOWELL SPRINGS BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2456
Mailing Address - Country:US
Mailing Address - Phone:865-966-7337
Mailing Address - Fax:865-966-7339
Practice Address - Street 1:10025 INVESTMENT DR
Practice Address - Street 2:STE 140
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37932-2664
Practice Address - Country:US
Practice Address - Phone:865-966-7337
Practice Address - Fax:865-966-7339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNAPPLYING FOROtherAPPLYING FOR MEDICARE PIN