Provider Demographics
NPI:1932138849
Name:REGIONAL EYE CENTER, PC
Entity Type:Organization
Organization Name:REGIONAL EYE CENTER, PC
Other - Org Name:THE REGIONAL EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-246-7372
Mailing Address - Street 1:135 W RAVINE RD
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3847
Mailing Address - Country:US
Mailing Address - Phone:423-246-7372
Mailing Address - Fax:423-578-4369
Practice Address - Street 1:135 W RAVINE RD
Practice Address - Street 2:SUITE 2C
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3847
Practice Address - Country:US
Practice Address - Phone:423-246-7372
Practice Address - Fax:423-578-4369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3700886Medicare ID - Type Unspecified
TN0650680001Medicare NSC