Provider Demographics
NPI:1568622413
Name:KNOXVILLE OPHTHALMOLOGY ASC, LLC
Entity Type:Organization
Organization Name:KNOXVILLE OPHTHALMOLOGY ASC, LLC
Other - Org Name:EYE SURGERY CENTER OF EAST TENNESSEE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-665-1283
Mailing Address - Street 1:1A BURTON HILLS BLVD
Mailing Address - Street 2:ATTN: L&C
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-6103
Mailing Address - Country:US
Mailing Address - Phone:865-588-1037
Mailing Address - Fax:865-909-9104
Practice Address - Street 1:1124 E WEISGARBER RD STE 110
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2600
Practice Address - Country:US
Practice Address - Phone:865-588-1037
Practice Address - Fax:865-909-9104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-13
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3628551Medicare UPIN
TN36285512Medicare UPIN
TN3708705Medicare PIN