Provider Demographics
NPI:1790320174
Name:NORTHSHORE SPECIALTY EYECARE PLLC
Entity Type:Organization
Organization Name:NORTHSHORE SPECIALTY EYECARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:423-677-9089
Mailing Address - Street 1:2053 THUNDERHEAD RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-9488
Mailing Address - Country:US
Mailing Address - Phone:865-288-4449
Mailing Address - Fax:
Practice Address - Street 1:2053 THUNDERHEAD RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-9488
Practice Address - Country:US
Practice Address - Phone:865-288-4449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-09
Last Update Date:2019-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty