Organization
SOUTHEAST EYE SPECIALISTS PLLC
Active
Parent organization
SOUTHEAST EYE SPECIALISTS, PLLC
Other names
SouthEast Eye Specialists Middle TN
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHEAST EYE SPECIALISTS, PLLC
Authorized official
STACEY MICHELLE CRUDUP (CHIEF COMPLIANCE OFFICER)
(615) 234-0450
Entity
Organization
Contact information
Practice address
28 WHITE BRIDGE ROAD, SUITE 208, NASHVILLE, TN 37205
(615) 327-2001
Mailing address
341 COOL SPRINGS BLVD STE 400, FRANKLIN, TN 37067-7224
(423) 508-7337
(423) 508-7338
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
207W00000X
Ophthalmology Physician
Primary
—
—
207WX0009X
Glaucoma Specialist (Ophthalmology) Physician
—
—
207WX0107X
Retina Specialist (Ophthalmology) Physician
—
—
207WX0110X
Pediatric Ophthalmology and Strabismus Specialist Physician
—
—
207WX0120X
Cornea and External Diseases Specialist Physician
—
—
207WX0200X
Ophthalmic Plastic and Reconstructive Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3721447
MEDICARE PIN
TN
05
—
3721447
—
TN
05
—
524169578A
—
GA
01
—
GRP6156
MEDICARE PIN
—
05
—
GRP6156
—
GA
Enumeration date
04/29/2020
Last updated
10/28/2020
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