Provider Demographics
NPI:1134243751
Name:EYE CENTERS OF TENNESSEE, LLC
Entity type:Organization
Organization Name:EYE CENTERS OF TENNESSEE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRONT OFFICE CREDENTIALS
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BREEDING
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:931-456-2728
Mailing Address - Street 1:15 IRIS LN
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-7528
Mailing Address - Country:US
Mailing Address - Phone:931-456-2728
Mailing Address - Fax:931-456-5446
Practice Address - Street 1:802 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TN
Practice Address - Zip Code:38570-1722
Practice Address - Country:US
Practice Address - Phone:931-400-5154
Practice Address - Fax:931-400-5155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3943261Medicaid
TN0137930002Medicare NSC
TNT61219Medicare UPIN
TN3943264Medicare PIN
TN3724245Medicare PIN
TNA99553Medicare UPIN
TNT61230Medicare UPIN
TNT61193Medicare UPIN
TN3943261Medicaid
TNV05999Medicare UPIN