1891135166 NPI number — EAST TENNESSEE EYECARE ASSOCIATES, PC

Table of content: (NPI 1891135166)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891135166 NPI number — EAST TENNESSEE EYECARE ASSOCIATES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST TENNESSEE EYECARE ASSOCIATES, 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:
1891135166
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 39
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURPHY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28906-0039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-837-5404
Provider Business Mailing Address Fax Number:
828-837-5621

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
144 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
COPPERHILL
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37317-5005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-496-6336
Provider Business Practice Location Address Fax Number:
423-496-6307
Provider Enumeration Date:
07/01/2013

Additional Information

Authorized Official

Authorized Official Last Name:
EICHENBAUM
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
828-837-5404

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  MD0000049024 , 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)





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