Provider Demographics
NPI:1952484354
Name:EAST TENNESSEE EYE SURGEONS, P.C.
Entity Type:Organization
Organization Name:EAST TENNESSEE EYE SURGEONS, P.C.
Other - Org Name:WILLIAM N. WILLIFORD, M.D. P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR/OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:TURNER
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-546-1464
Mailing Address - Street 1:7800 CONNER RD
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-3511
Mailing Address - Country:US
Mailing Address - Phone:865-546-1464
Mailing Address - Fax:865-546-0470
Practice Address - Street 1:7800 CONNER RD
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-3511
Practice Address - Country:US
Practice Address - Phone:865-546-1464
Practice Address - Fax:865-546-0470
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST TENNESSEE EYE SURGEONS, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-23
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD007146261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3053006Medicaid
TN3815285Medicaid
TN3166232Medicaid
TNE14744Medicare UPIN
TN3053006Medicaid
TNB03162Medicare UPIN
TN3166232Medicaid
TNI62052Medicare UPIN
TN3701702Medicare PIN