1962948737 NPI number — EAST TENNESSEE BINOCULAR VISION CENTER PLLC

Table of content: (NPI 1962948737)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962948737 NPI number — EAST TENNESSEE BINOCULAR VISION CENTER PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST TENNESSEE BINOCULAR VISION CENTER 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:
1962948737
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/17/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P O BOX 32367
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37930-2367
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-437-3166
Provider Business Mailing Address Fax Number:
865-851-9328

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9051 EXECUTIVE PARK DR.,
Provider Second Line Business Practice Location Address:
STE. 400
Provider Business Practice Location Address City Name:
KNOXVVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-437-3166
Provider Business Practice Location Address Fax Number:
865-851-9328
Provider Enumeration Date:
01/17/2017

Additional Information

Authorized Official

Authorized Official Last Name:
RHYNE
Authorized Official First Name:
MILES
Authorized Official Middle Name:
W
Authorized Official Title or Position:
SOLE MBR
Authorized Official Telephone Number:
865-437-3166

Provider Taxonomy Codes

  • Taxonomy code: 152WV0400X , with the licence number:  TN0560 , 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)





Copyright © 2007-2025 www.npivalidator.com