Organization
SOUTHEAST EYE SPECIALISTS, PLLC
Active
Parent organization
SOUTHEAST EYE SPECIALISTS, PLLC
Other names
SouthEast Eye Specialists - Soddy Daisy
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHEAST EYE SPECIALISTS, PLLC
Authorized official
MRS. STACEY MICHELLE CRUDUP (CHIEF COMPLIANCE OFFICER)
(615) 234-0450
Entity
Organization
Contact information
Practice address
9453 DAYTON PIKE, SODDY DAISY, TN 37379-4751
(423) 508-7337
(423) 508-7338
Mailing address
341 COOL SPRINGS BLVD STE 400, FRANKLIN, TN 37067-7224
(615) 349-8965
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3721447
MEDICARE PIN
—
05
—
524169578A
—
GA
01
—
GRP6156
MEDICARE PIN
—
Enumeration date
10/26/2020
Last updated
10/28/2020
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