Provider Demographics
NPI:1629195797
Name:KNOXVILLE EYE CENTER LLC
Entity Type:Organization
Organization Name:KNOXVILLE EYE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-694-2021
Mailing Address - Street 1:200 FORT SANDERS WEST BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3358
Mailing Address - Country:US
Mailing Address - Phone:865-694-2021
Mailing Address - Fax:865-694-8234
Practice Address - Street 1:200 FORT SANDERS WEST BLVD
Practice Address - Street 2:STE 101
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3357
Practice Address - Country:US
Practice Address - Phone:865-694-2021
Practice Address - Fax:865-694-8234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD022058207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN180037897OtherRAILROAD MEDICARE
TN3073686OtherBLUECROSS
TN1283940001Medicare NSC
TN3065686Medicare PIN
TN180037897OtherRAILROAD MEDICARE