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Organization
WILSON COUNTY EYE SURGERY CENTER, LLC
Active
Organization
WILSON COUNTY EYE SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. VIVIAN L RAGSDALE (BILLING MANAGER)
(615) 453-4906
Entity
Organization
Contact information
Practice address
1670 W MAIN ST, SUITE 120, LEBANON, TN 37087-1344
(615) 453-5155
Mailing address
1670 WEST MAIN ST, SUITE 120, LEBANON, TN 37087
(615) 453-5155
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
103
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3122518
BLUE CROSS BLUE SHIELD
TN
05
—
3288111
—
TN
01
—
490005524
RR MEDICARE
TN
Enumeration date
01/30/2007
Last updated
02/02/2009
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