Provider Demographics
NPI:1982035952
Name:MIDDLE TENNESSEE EYECARE PLLC
Entity Type:Organization
Organization Name:MIDDLE TENNESSEE EYECARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:B
Authorized Official - Last Name:COSTELLO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:615-626-2988
Mailing Address - Street 1:2126 ABBOTT MARTIN RD STE 142
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2609
Mailing Address - Country:US
Mailing Address - Phone:615-626-2988
Mailing Address - Fax:615-523-1690
Practice Address - Street 1:2126 ABBOTT MARTIN RD STE 142
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-2609
Practice Address - Country:US
Practice Address - Phone:615-626-2988
Practice Address - Fax:615-523-1690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-02
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2727152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty