Provider Demographics
NPI:1134567845
Name:PHELPS EYE CARE, PLLC
Entity type:Organization
Organization Name:PHELPS EYE CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:PHELPS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:731-514-8623
Mailing Address - Street 1:138 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TN
Mailing Address - Zip Code:38340-2323
Mailing Address - Country:US
Mailing Address - Phone:731-989-3511
Mailing Address - Fax:731-989-3515
Practice Address - Street 1:138 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TN
Practice Address - Zip Code:38340-2323
Practice Address - Country:US
Practice Address - Phone:731-989-3511
Practice Address - Fax:731-989-3515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-05
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty