1982802559 NPI number — SOUTHERN TENNESSEE EYE SPECIALISTS INC.

Table of content: (NPI 1982802559)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982802559 NPI number — SOUTHERN TENNESSEE EYE SPECIALISTS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN TENNESSEE EYE SPECIALISTS INC.
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:
1982802559
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
336 POPLAR VIEW PKWY
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
COLLIERVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38017-3436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-854-6220
Provider Business Mailing Address Fax Number:
901-854-6808

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
336 POPLAR VIEW PKWY
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
COLLIERVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38017-3436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-854-6220
Provider Business Practice Location Address Fax Number:
901-854-6808
Provider Enumeration Date:
07/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KAVOUSSI
Authorized Official First Name:
HAROLD
Authorized Official Middle Name:
PETER
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
901-854-6220

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  12179 , 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: 1982802559 . This is a "GROUP NPI" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1871694877 . This is a "PERSONAL NPI NUMBER" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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