1518135292 NPI number — JESSUP EYE CARE, INC

Table of content: (NPI 1518135292)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518135292 NPI number — JESSUP EYE CARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JESSUP EYE CARE, INC
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:
1518135292
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7640 HIGHWAY 70 S
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37221-1758
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-662-2800
Provider Business Mailing Address Fax Number:
615-662-2001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7640 HIGHWAY 70 S
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37221-1758
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-662-2800
Provider Business Practice Location Address Fax Number:
615-662-2001
Provider Enumeration Date:
02/14/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JESSUP
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
CARR
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
615-662-2800

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  ODT000859 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0047504 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0792070001 . This is a "MEDICARE DMERC PIN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".