Provider Demographics
NPI:1578807269
Name:FIVE RIVERS EYECARE PLLC
Entity Type:Organization
Organization Name:FIVE RIVERS EYECARE PLLC
Other - Org Name:YANDELL EYECARE CENTER, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OD/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:YANDELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:423-623-2020
Mailing Address - Street 1:115 HEDRICK DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37821
Mailing Address - Country:US
Mailing Address - Phone:423-623-2020
Mailing Address - Fax:423-623-3937
Practice Address - Street 1:1411 W MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-2828
Practice Address - Country:US
Practice Address - Phone:423-587-3474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-19
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00332301OtherMEDICARE RAILROAD
TN3137807OtherBLUECROSS BLUESHIELD
TN3137807Medicaid
TNU32999Medicare UPIN
TN3137807Medicaid
TN3918780001Medicare NSC