1750533659 NPI number — CLEVELAND EYE CARE, PLLC

Table of content: EMILY MCCLUNG (NPI 1740915040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750533659 NPI number — CLEVELAND EYE CARE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLEVELAND EYE CARE, PLLC
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:
1750533659
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3463 WILLOW OAK CIR NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37312-1749
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-476-4855
Provider Business Mailing Address Fax Number:
423-303-1978

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3463 WILLOW OAK CIR NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37312-1749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-476-4855
Provider Business Practice Location Address Fax Number:
423-303-1978
Provider Enumeration Date:
10/22/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCGUIRE
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
423-284-9569

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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