Provider Demographics
NPI:1750942363
Name:FAYETTE EYE ASSOCIATES PLLC
Entity type:Organization
Organization Name:FAYETTE EYE ASSOCIATES PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING AND CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-757-2020
Mailing Address - Street 1:3161 HIGHWAY 64 STE 500
Mailing Address - Street 2:
Mailing Address - City:EADS
Mailing Address - State:TN
Mailing Address - Zip Code:38028-3370
Mailing Address - Country:US
Mailing Address - Phone:901-465-3130
Mailing Address - Fax:901-234-0133
Practice Address - Street 1:3161 HIGHWAY 64 STE 500
Practice Address - Street 2:
Practice Address - City:EADS
Practice Address - State:TN
Practice Address - Zip Code:38028-3370
Practice Address - Country:US
Practice Address - Phone:901-465-3130
Practice Address - Fax:901-234-0133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-25
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center