Provider Demographics
NPI:1245340603
Name:MOUNTAIN EMPIRE CATARACT & EYE SURGERY CENTER
Entity type:Organization
Organization Name:MOUNTAIN EMPIRE CATARACT & EYE SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-661-7762
Mailing Address - Street 1:2010 BREMO RD STE 128A
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-2444
Mailing Address - Country:US
Mailing Address - Phone:877-969-0392
Mailing Address - Fax:
Practice Address - Street 1:3185 W STATE ST
Practice Address - Street 2:SUITE 2020
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-1610
Practice Address - Country:US
Practice Address - Phone:423-968-4141
Practice Address - Fax:423-968-7641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN152261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00056474OtherRAILROAD MEDICARE
TNTN0101OtherJOHN DEERE HEALTH CARE
VA010024676Medicaid
TN4068468OtherBLUE CROSS BLUE SHIELD
VA019997OtherANTHEM
VA019997OtherANTHEM