Sandy L Mysliwiec, O.D.
Individual provider Active NPI Optometrist · Jacksboro, TN
NPI 1285860841 · NPPES record last updated Mar 31, 2022
Key facts
- NPI
- 1285860841
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 1926 (TN)
- Practice address
- 2523 Jacksboro Pike
Jacksboro, TN 37757-4847 - Phone
- (423) 566-2020
- Fax
- (423) 566-4245
- NPI assigned
- Jun 9, 2009
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040602000889 | TN | Practitioner - Optometry | 6305828526 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1926 | TN | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Associates in Eye Care, Inc. | Optometrist | Current |
Accepting new patients |
| Associates in Eye Care, Inc. | Optometrist | Current | Accepting new patients |
| Associates in Eye Care, Inc. | Optometrist | Current |
Accepting new patients |
Locations
127 Foothills Ave
Ste 3
Albany, KY 42602
Phone (606) 376-5258
2523 Jacksboro Pike
Jacksboro, TN 37757
Phone (423) 556-2020
16605 Alberta St
Oneida, TN 37841
Phone (423) 569-9339
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1926 | TN | Yes |
Addresses
Primary practice location
2523 Jacksboro Pike
Jacksboro, TN 37757-4847
Mailing address
PO Box 296
Ferguson, KY 42533-0296
Phone (606) 492-2211
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285860841 | Other | HUMANA | |
| 9356427 | Other | AETNA | |
| 4247102 | Other | TN | BCBSTN/BLUECARE/TENNCARE |
| P01993204 | Other | TN | RR MEDICARE |
| 1285860841 | Other | MARCH VISION | |
| 5668218 | Other | CIGNA | |
| 0487990009 | Other | TN | JACKSBORO GROUP MEDICARE DME PTAN |
| 12282 | Other | SUPERIOR VISION | |
| 1285860841 | Other | AMERIGROUP | |
| 3941347 | Other | TN | TN MEDICARE GROUP JACKSBORO |
| 103I415299 | Other | TN | MEDICARE PTAN |
| 3942271 | Medicaid | TN | |
| 0487990010 | Other | TN | MAYNARDVILLE GROUP MEDICARE PTAN DME |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | COMPULINK | Health Information Exchange (HIE) |
Other providers in Jacksboro, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 31, 2022. 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.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.