Organization Active NPI

Eyecare Plus CL PLLC

  • Optometrist
  • Clarksville, TN
National Provider Identifier
1104871037
Registry record updated Apr 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
EYECARE PLUS CL PLLC
Practice address
2024 Wilma Rudolph Blvd
Clarksville, TN 37040-6879
Phone
(931) 551-3031
Fax
(931) 552-7488
NPI assigned
May 22, 2006
Reactivated
Apr 24, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Cheyanne Mullis
Title
Office Manager
Phone
(615) 988-5303

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

2024 Wilma Rudolph Blvd
Clarksville, TN 37040-6879

Mailing address

2024 Wilma Rudolph Blvd
Suite C
Clarksville, TN 37040-6620
Phone (931) 551-3031

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031118000032 TN Part B Supplier - Clinic/Group Practice 3870407406 Receives reassigned benefits from 11 practitioners
Practice locations: Clarksville, TN

National Provider Directory

National Provider Directory

Locations

5323 Mount View Rd
Antioch, TN 37013
Phone (615) 731-8900

2024 Wilma Rudolph Blvd
Clarksville, TN 37040
Phone (931) 551-3031

1911 Glen Echo Rd
Nashville, TN 37215
Phone (615) 298-2668

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 20

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713916800000",
    "number": "1104871037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2024 WILMA RUDOLPH BLVD",
            "address_2": "SUITE C",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370406620",
            "telephone_number": "931-551-3031",
            "fax_number": "931-552-7488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2024 WILMA RUDOLPH BLVD",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370406879",
            "telephone_number": "931-551-3031",
            "fax_number": "931-552-7488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYECARE PLUS CL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-22",
        "last_updated": "2024-04-24",
        "certification_date": "2021-08-05",
        "deactivation_date": "2024-02-23",
        "reactivation_date": "2024-04-24",
        "status": "A",
        "authorized_official_last_name": "MULLIS",
        "authorized_official_first_name": "CHEYANNE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "615-988-5303"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarksville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.