Provider Demographics
NPI:1205315496
Name:MUSIC CITY EYE CARE LLC
Entity type:Organization
Organization Name:MUSIC CITY EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:615-203-5037
Mailing Address - Street 1:1121 TIBERIUS WAY
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-1507
Mailing Address - Country:US
Mailing Address - Phone:651-230-3554
Mailing Address - Fax:
Practice Address - Street 1:570 ENON SPRINGS RD E
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-4409
Practice Address - Country:US
Practice Address - Phone:615-203-5037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MUSIC CITY EYE CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3158152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty