Provider Demographics
NPI:1528603628
Name:ASCENT EYE CARE & EYEWEAR GALLERY PLLC
Entity Type:Organization
Organization Name:ASCENT EYE CARE & EYEWEAR GALLERY PLLC
Other - Org Name:ASCENT EYE CARE & EYEWEAR GALLERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:615-560-8245
Mailing Address - Street 1:762 ROLLING CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-4278
Mailing Address - Country:US
Mailing Address - Phone:615-560-8245
Mailing Address - Fax:615-560-8249
Practice Address - Street 1:1441 NEW HIGHWAY 96 W STE 3
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-4831
Practice Address - Country:US
Practice Address - Phone:615-560-8245
Practice Address - Fax:615-560-8249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-12
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ053813Medicaid