Provider Demographics
NPI:1578773263
Name:COMPLETE EYE CARE, PC
Entity Type:Organization
Organization Name:COMPLETE EYE CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BONNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-332-8222
Mailing Address - Street 1:9453 DAYTON PIKE
Mailing Address - Street 2:
Mailing Address - City:SODDY DAISY
Mailing Address - State:TN
Mailing Address - Zip Code:37379-4751
Mailing Address - Country:US
Mailing Address - Phone:423-332-8222
Mailing Address - Fax:423-332-8278
Practice Address - Street 1:9453 DAYTON PIKE
Practice Address - Street 2:
Practice Address - City:SODDY DAISY
Practice Address - State:TN
Practice Address - Zip Code:37379-4751
Practice Address - Country:US
Practice Address - Phone:423-332-8222
Practice Address - Fax:423-332-8278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000028919207W00000X
TN28919332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3375048Medicaid
TN4064430001Medicare NSC