Organization
EYE CENTERS OF TENNESSEE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TINA D BREEDING (FRONT OFFICE CREDENTIALING)
(931) 456-2728
Entity
Organization
Contact information
Practice address
220 N CHANCERY ST, MC MINNVILLE, TN 37110-2551
(931) 473-2487
(931) 473-8782
Mailing address
15 IRIS LN, CROSSVILLE, TN 38555-7528
(931) 456-2728
(931) 456-5446
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD3109
TN
207W00000X
Ophthalmology Physician
MD16334
TN
332B00000X
Durable Medical Equipment & Medical Supplies
MD9365
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q008842
—
TN
Enumeration date
02/13/2008
Last updated
04/26/2021
Update your record
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