Provider Demographics
NPI:1609955517
Name:KNOXVILLE EYE SURGERY CENTER LLC
Entity Type:Organization
Organization Name:KNOXVILLE EYE SURGERY CENTER LLC
Other - Org Name:TENNESSEE VALLEY EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-251-0338
Mailing Address - Street 1:160 CAPITAL DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3343
Mailing Address - Country:US
Mailing Address - Phone:865-251-0338
Mailing Address - Fax:865-985-0325
Practice Address - Street 1:160 CAPITAL DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3343
Practice Address - Country:US
Practice Address - Phone:865-251-0338
Practice Address - Fax:865-985-0325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000093261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3288304Medicaid
TN490004267OtherCRMC OF TN
KY7600000800OtherKYMK
TN3123485OtherBCBS OF TN