Provider Demographics
NPI:1730106220
Name:EYE CARE GROUP, PLLC
Entity Type:Organization
Organization Name:EYE CARE GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:AGEE
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:731-784-1186
Mailing Address - Street 1:PO BOX 509
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:TN
Mailing Address - Zip Code:38343-0509
Mailing Address - Country:US
Mailing Address - Phone:731-784-1186
Mailing Address - Fax:731-784-8228
Practice Address - Street 1:2439 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:TN
Practice Address - Zip Code:38343-1753
Practice Address - Country:US
Practice Address - Phone:731-784-1186
Practice Address - Fax:731-784-8228
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYE CARE GROUP, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-17
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4105755OtherBLUE CROSS BLUE SHIELD
TN5466560001Medicare NSC