Provider Demographics
NPI:1972095172
Name:ROGERS EYE CENTER PC
Entity Type:Organization
Organization Name:ROGERS EYE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-925-6225
Mailing Address - Street 1:285 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:TN
Mailing Address - Zip Code:38372-2050
Mailing Address - Country:US
Mailing Address - Phone:731-925-6225
Mailing Address - Fax:731-925-0235
Practice Address - Street 1:285 MAIN ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:TN
Practice Address - Zip Code:38372-2050
Practice Address - Country:US
Practice Address - Phone:731-925-6225
Practice Address - Fax:731-925-0235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-04
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000000711152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1780612598Medicaid
TN1487182754Medicaid