Provider Demographics
NPI:1760516017
Name:WEST TENNESSEE EYE, PLC
Entity Type:Organization
Organization Name:WEST TENNESSEE EYE, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:K
Authorized Official - Last Name:TALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:901-357-0371
Mailing Address - Street 1:8120 HWY 51N, STE 7
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38053
Mailing Address - Country:US
Mailing Address - Phone:901-872-2020
Mailing Address - Fax:901-873-1199
Practice Address - Street 1:8120 HWY 51N, STE 7
Practice Address - Street 2:
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38053
Practice Address - Country:US
Practice Address - Phone:901-872-2020
Practice Address - Fax:901-873-1199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1797152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3941290Medicare ID - Type UnspecifiedGROUP PRACTICE NUMBER
TN0261030002Medicare NSC
TN410040093Medicare PIN