Provider Demographics
NPI:1013102284
Name:BURNETT AND HUBBARD EYECARE PLLC
Entity Type:Organization
Organization Name:BURNETT AND HUBBARD EYECARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNETT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:731-668-4881
Mailing Address - Street 1:214 CARRIAGE HOUSE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3903
Mailing Address - Country:US
Mailing Address - Phone:731-668-4881
Mailing Address - Fax:731-668-5705
Practice Address - Street 1:214 CARRIAGE HOUSE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3903
Practice Address - Country:US
Practice Address - Phone:731-668-4881
Practice Address - Fax:731-668-5705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN886152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0227480001Medicare NSC