1548302854 NPI number — DONELSON EYECARE, PLLC

Table of content: (NPI 1548302854)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548302854 NPI number — DONELSON EYECARE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DONELSON EYECARE, 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:
SUSAN N. KEGARISE & ASSOCIATES
Provider Other Organization Name Type Code:
4
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:
1548302854
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3252 ASPEN GROVE DR STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37067-4894
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-786-9044
Provider Business Mailing Address Fax Number:
615-905-4655

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2378 LEBANON PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37214-2411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-889-0147
Provider Business Practice Location Address Fax Number:
615-889-2700
Provider Enumeration Date:
02/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COLWELL
Authorized Official First Name:
GINGER
Authorized Official Middle Name:
Authorized Official Title or Position:
INSURANCE DIRECTOR
Authorized Official Telephone Number:
615-786-9044

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 1459 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152WC0802X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1532322 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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