Provider Demographics
NPI:1598746794
Name:CLARKSVILLE OPHTHALMOLOGY P.C.
Entity Type:Organization
Organization Name:CLARKSVILLE OPHTHALMOLOGY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:C
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:FITCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-552-6830
Mailing Address - Street 1:141 CHESAPEAKE LANE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040
Mailing Address - Country:US
Mailing Address - Phone:931-552-6830
Mailing Address - Fax:931-552-2847
Practice Address - Street 1:141 CHESAPEAKE LANE
Practice Address - Street 2:SUITE 300
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040
Practice Address - Country:US
Practice Address - Phone:931-552-6830
Practice Address - Fax:931-552-2847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-07
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3375635Medicare ID - Type Unspecified