1073524096 NPI number — UNIVERSITY EYE SPECIALISTS, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073524096 NPI number — UNIVERSITY EYE SPECIALISTS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY EYE SPECIALISTS, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073524096
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/05/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1932 ALCOA HWY STE 255
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37920
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-244-2020
Provider Business Mailing Address Fax Number:
865-410-7292

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
622 SMITHVIEW DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARYVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37803-6100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-681-1234
Provider Business Practice Location Address Fax Number:
865-982-9746
Provider Enumeration Date:
08/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PITT
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
865-244-2020

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0727320003 . This is a "DMERC - MVO" identifier . This identifiers is of the category "OTHER".