Provider Demographics
NPI:1629247762
Name:.JESSUP EYE CARE, INC
Entity Type:Organization
Organization Name:.JESSUP EYE CARE, INC
Other - Org Name:THOMPSON LANE EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:CARR
Authorized Official - Last Name:JESSUP
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:615-513-0385
Mailing Address - Street 1:7640 HIGHWAY 70 S
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-1758
Mailing Address - Country:US
Mailing Address - Phone:615-662-2800
Mailing Address - Fax:615-662-0411
Practice Address - Street 1:181 THOMPSON LN
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-2411
Practice Address - Country:US
Practice Address - Phone:615-333-1717
Practice Address - Fax:615-333-9245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT000859152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4932109OtherCIGNA
TN0792070001OtherMEDICARE DMERC
TN0792070001OtherMEDICARE DMERC
TN3505039Medicare PIN
TN4932109OtherCIGNA
TN3505038Medicare PIN