Provider Demographics
NPI:1841351269
Name:SULLINS EYE CARE P.C.
Entity type:Organization
Organization Name:SULLINS EYE CARE P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTA
Authorized Official - Middle Name:H
Authorized Official - Last Name:SULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:423-745-4970
Mailing Address - Street 1:PO BOX 666
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37371-0666
Mailing Address - Country:US
Mailing Address - Phone:423-745-4910
Mailing Address - Fax:423-745-2230
Practice Address - Street 1:517 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-3621
Practice Address - Country:US
Practice Address - Phone:423-745-4910
Practice Address - Fax:423-745-2230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD0000001689152W00000X, 332H00000X
TNOD0000001899152W00000X, 332H00000X
TNOD0000001722332H00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3590906Medicare PIN