Provider Demographics
NPI:1598374902
Name:EYESTHETICS PLLC
Entity Type:Organization
Organization Name:EYESTHETICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MD
Authorized Official - Prefix:
Authorized Official - First Name:TREY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-221-9544
Mailing Address - Street 1:306 LANDRUM PL
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-4648
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:306 LANDRUM PL
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4648
Practice Address - Country:US
Practice Address - Phone:931-221-9544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty