1609868363 NPI number — CAMDEN EYE CARE ASSOCIATES

Table of content: (NPI 1609868363)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609868363 NPI number — CAMDEN EYE CARE ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAMDEN EYE CARE ASSOCIATES
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:
1609868363
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
264 HIGHWAY 641 N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMDEN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38320-1329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
731-584-7942
Provider Business Mailing Address Fax Number:
731-584-7965

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
264 HIGHWAY 641 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMDEN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38320-1329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-584-7942
Provider Business Practice Location Address Fax Number:
731-584-7965
Provider Enumeration Date:
08/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
REYNOLDSON
Authorized Official First Name:
TONYA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
731-584-7942

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OD0000002255 , 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: 50537 . This is a "DAVIS VISION" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 7536377 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 11494632 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3945315 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1012691-0556551 . This is a "BLOCKVISION" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4076769 . This is a "TENNCARE SELECT" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 50537 . This is a "BETTERHEALTH" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4076769 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: P00193746-DC310 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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