Provider Demographics
NPI:1700827961
Name:JOHNSON CITY EYE CLINIC PC
Entity Type:Organization
Organization Name:JOHNSON CITY EYE CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-929-2111
Mailing Address - Street 1:110 MED TECH PKWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-4004
Mailing Address - Country:US
Mailing Address - Phone:423-929-2111
Mailing Address - Fax:423-929-0497
Practice Address - Street 1:110 MED TECH PKWY
Practice Address - Street 2:SUITE 1
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-4004
Practice Address - Country:US
Practice Address - Phone:423-929-2111
Practice Address - Fax:423-929-0497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD6474207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNCH8361OtherRAILROAD MEDICARE
VACJ4025OtherRAILROAD MEDICARE
TNCK0468OtherRAILROAD MEDICARE
TN3384013Medicare PIN
VACJ4025OtherRAILROAD MEDICARE
TN0284010001Medicare NSC
TN3943399Medicare PIN
TN3384015Medicare PIN
TNCK0468OtherRAILROAD MEDICARE
TN0284010002Medicare NSC
KY00695Medicare PIN