Eye Centers of Tennessee, LLC
Organization Active NPI Ophthalmology Physician · Crossville, TN
NPI 1104940790 · NPPES record last updated Apr 26, 2021
Key facts
- NPI
- 1104940790
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Ophthalmology Physician 207W00000X
- Legal business name
- EYE CENTERS OF TENNESSEE, LLC
- Practice address
- 15 Iris LN
Crossville, TN 38555-7528 - Phone
- (931) 456-2728
- Fax
- (931) 456-5446
- NPI assigned
- Mar 19, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. Raymond K Mays
- Title
- Administrator
- Phone
- (931) 456-2728
Other NPIs on the same Medicare enrollment 8
Other NPIs with the same Medicare PAC ID 7
Practitioners 20
-
Philip M Brock, OD
-
James M Grisolano Jr., M.D.
-
Amy S. Johnson, M.D.
-
Andrew David Johnson, M.D.
-
Amanda J Kirk, O.D.
-
David F Merritt, OD
-
Joshua Oliver, OD
-
Michael David Patterson, D.O.
-
Holly N Pendel, OD
-
Stephen M Richardson, O.D.
-
Jordan D Smith, O.D.
-
Larry E. Patterson, M.D.
-
Steven K Birge, O.D.
-
Cory J. Bosanko, O.D.
-
Emily Ann Gaines, AU.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D2086504 | Eye Centers of Tennessee | Certificate of waiver | Nov 4, 2026 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Eye Centers of Tennessee, LLC |
Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080826000107 | TN | Part B Supplier - Clinic/Group Practice | 1355379256 |
Receives reassigned benefits from 17 practitioners 12 other NPIs on this enrollment Practice locations: Cookeville, TN; Crossville, TN; Jamestown, TN; Livingston, TN; McMinnville, TN; Pikeville, TN; Sparta, TN |
| O20100930033420 | TN | DME Supplier - Physician - Ophthalmology |
1355379256 | Practice locations: Crossville, TN |
National Provider Directory
Locations
15 Iris Ln
Crossville, TN 38555
Phone (931) 456-2728
802 W Main St
Livingston, TN 38570
Phone (931) 400-5154
Interoperability endpoints
- mpage@ecotn.intellechartdirect.net
- ksmith@ecotn.intellechartdirect.net
- pbrock@ecotn.intellechartdirect.net
- srichardson@ecotn.intellechartdirect.net
- jpeek@ecotn.intellechartdirect.net
- joliver@ecotn.intellechartdirect.net
- akirk@ecotn.intellechartdirect.net
- jgrisolano@ecotn.intellechartdirect.net
- acadis@ecotn.intellechartdirect.net
- lpatterson@ecotn.intellechartdirect.net
- mpatterson@ecotn.intellechartdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | |||
| Optician |
156FX1800X | |||
| Ophthalmology Physician |
207W00000X | Yes | ||
| Durable Medical Equipment & Medical Supplies | 332B00000X | MD16334 | TN |
Addresses
Primary practice location
15 Iris LN
Crossville, TN 38555-7528
Mailing address
15 Iris LN
Crossville, TN 38555-7528
Phone (931) 456-2728
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3943261 | Medicaid | TN | |
| 3144522 | Other | TN | BLUE CROSS BLUE SHIELD |
Other providers in Crossville, TN
- Felicia Engebrecht
- Elizabeth W England
- Ashley Eppolito
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- Exac Care, PLLC
- Fairfield Glade of Tennessee, LLC
- Aniqa Faraz
- Gary Justin Farr
- Fast Pace Medical Clinic PLLC
- Alyssa Danielle-Hall Ferrell
All providers in Crossville, TN · Ophthalmology Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 26, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.