Provider Demographics
NPI:1457523862
Name:EYEDOC, PC
Entity Type:Organization
Organization Name:EYEDOC, PC
Other - Org Name:DR. JEFFREY SILBERNAGEL,OD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:SILBERNAGEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:504-616-4780
Mailing Address - Street 1:445 W BLOUNT AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1106
Mailing Address - Country:US
Mailing Address - Phone:865-288-3235
Mailing Address - Fax:865-288-7714
Practice Address - Street 1:10745 KINGSTON PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-3002
Practice Address - Country:US
Practice Address - Phone:865-288-3235
Practice Address - Fax:865-288-7714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1340152W00000X
LA5585231H00000X
LA1057-264T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ008339Medicaid