Provider Demographics
NPI:1609969682
Name:MOUNTAIN EMPIRE EYE PHYSICIANS PLLC
Entity Type:Organization
Organization Name:MOUNTAIN EMPIRE EYE PHYSICIANS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STACY
Authorized Official - Middle Name:F
Authorized Official - Last Name:PERDUE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:423-968-7555
Mailing Address - Street 1:3185 WEST STATE STREET
Mailing Address - Street 2:SUITE 2010
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620
Mailing Address - Country:US
Mailing Address - Phone:423-968-7555
Mailing Address - Fax:423-968-7641
Practice Address - Street 1:3185 WEST STATE STREET
Practice Address - Street 2:SUITE 2010
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620
Practice Address - Country:US
Practice Address - Phone:423-968-7555
Practice Address - Fax:423-968-7641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACG3621OtherRAILROAD MEDICARE
VACG3622OtherRAILROAD MEDICARE
GACG3621OtherRAILROAD MEDICARE
VACG3622OtherRAILROAD MEDICARE