Provider Demographics
NPI:1497809248
Name:ADVANCED EYE CARE,P.C.
Entity Type:Organization
Organization Name:ADVANCED EYE CARE,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:DEBARGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-403-4202
Mailing Address - Street 1:980 HIGHWAY 28 STE 104
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TN
Mailing Address - Zip Code:37347-3696
Mailing Address - Country:US
Mailing Address - Phone:423-403-4202
Mailing Address - Fax:423-403-4207
Practice Address - Street 1:980 HIGHWAY 28 STE 104
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TN
Practice Address - Zip Code:37347-3696
Practice Address - Country:US
Practice Address - Phone:423-403-4202
Practice Address - Fax:423-403-4207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035850207W00000X
207W00000X, 207WX0108X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No207WX0108XAllopathic & Osteopathic PhysiciansOphthalmologyUveitis and Ocular Inflammatory DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F33155Medicare UPIN
TN3069468Medicare PIN
GA18BDCZBMedicare PIN