Organization
EYE CARE CENTER ASSOCIATES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARYL DEMONBREUN (ADMINISTRATOR)
(931) 393-2020
Entity
Organization
Contact information
Practice address
1100 N JACKSON ST, TULLAHOMA, TN 37388-2336
(931) 393-2020
(931) 455-6501
Mailing address
1100 N JACKSON ST, TULLAHOMA, TN 37388-2336
(931) 393-2020
(931) 455-6501
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
207W00000X
Ophthalmology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0534110001
MEDICARE DME
TN
05
—
3702334
—
TN
05
—
3940053
—
TN
01
—
C30028
RAILROAD MEDICARE MD'S AND OD'S GROUP
TN
Enumeration date
09/13/2005
Last updated
10/16/2012
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