Provider Demographics
NPI:1700905239
Name:TOOMEY & BAGGETT EYECARE CLINIC, PLLC
Entity Type:Organization
Organization Name:TOOMEY & BAGGETT EYECARE CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE AND BILLING DEPT.
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-746-9988
Mailing Address - Street 1:406 W MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303-4232
Mailing Address - Country:US
Mailing Address - Phone:423-746-9988
Mailing Address - Fax:423-746-9984
Practice Address - Street 1:406 W MADISON AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-4232
Practice Address - Country:US
Practice Address - Phone:423-746-9988
Practice Address - Fax:423-746-9984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNT923152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1298940001Medicare NSC
TNT81682Medicare UPIN