NPIMap

Organization Active NPI

Skyline Eye Clinic, PC

Doing business as Eye Clinic, PC

  • Ophthalmology Physician
  • Jackson, TN
National Provider Identifier
1154328813
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
SKYLINE EYE CLINIC, PC
Doing business as
Eye Clinic, PC
Practice address
668 Skyline Dr
Jackson, TN 38301-3951
Phone
(731) 424-2414
Fax
(731) 424-4444
NPI assigned
Jul 7, 2005
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Raymond James Kee
Title
Administrator
Phone
(731) 424-2414

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

668 Skyline Dr
Jackson, TN 38301-3951

Mailing address

668 Skyline Dr
Jackson, TN 38301-3951
Phone (731) 424-2414

Other names 1

  • Eye Clinic, PC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050602001098 TN Part B Supplier - Clinic/Group Practice 0042253882 Receives reassigned benefits from 10 practitioners
Practice locations: Henderson, TN; Jackson, TN; Selmer, TN
O20251112000024 TN DME Supplier - Physician - Ophthalmology 0042253882 Practice locations: Jackson, TN

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D0965786Eye Clinic668 Skyline Drive, Jackson, TN 38301Certificate of waiverSep 28, 2027

National Provider Directory

National Provider Directory

Locations

138 S Washington Ave
Henderson, TN 38340
Phone (731) 989-3511

19028 Main St W
Huntingdon, TN 38344
Phone (731) 968-4162

1340 Union University Dr
Jackson, TN 38305
Phone (731) 215-1281

Interoperability endpoints

  • Direct secure messaging: cpersons@ecpc.intellechartdirect.net
  • Direct secure messaging: hgrissom@ecpc.intellechartdirect.net
  • Direct secure messaging: jsullivan@ecpc.intellechartdirect.net
  • Direct secure messaging: mlee@ecpc.intellechartdirect.net
  • Direct secure messaging: rnord@ecpc.intellechartdirect.net
  • Direct secure messaging: shammond@ecpc.intellechartdirect.net
  • Direct secure messaging: sneel@ecpc.intellechartdirect.net
  • Direct secure messaging: sphelps@ecpc.intellechartdirect.net

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1154328813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "668 SKYLINE DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383013951",
            "telephone_number": "731-424-2414",
            "fax_number": "731-424-4444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "668 SKYLINE DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383013951",
            "telephone_number": "731-424-2414",
            "fax_number": "731-424-4444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SKYLINE EYE CLINIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KEE",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "731-424-2414",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eye Clinic, PC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.