Eye Centers of Tennessee, LLC
Organization Active NPI Optometrist · MC Minnville, TN
NPI 1306014378 · NPPES record last updated Apr 26, 2021
Key facts
- NPI
- 1306014378
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- OD3109 (TN)
- Legal business name
- EYE CENTERS OF TENNESSEE, LLC
- Practice address
- 220 N Chancery St
MC Minnville, TN 37110-2551 - Phone
- (931) 473-2487
- Fax
- (931) 473-8782
- NPI assigned
- Feb 13, 2008
- Organization subpart
- No
Authorized official
- Name
- Mrs. Tina D Breeding
- Title
- Front Office Credentialing
- Phone
- (931) 456-2728
Other NPIs on the same Medicare enrollment 8
Other NPIs with the same Medicare PAC ID 7
Corporate family (same tax ID) 7
Practitioners 18
-
Andrew David Johnson, M.D.
-
Larry E. Patterson, M.D.
-
Philip M Brock, OD
-
James M Grisolano Jr., M.D.
-
Amy S. 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.
-
Steven K Birge, O.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D2090404 | Eye Centers of Tennessee | Certificate of waiver | Jan 21, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Eye Centers of Tennessee |
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 This NPI is an additional NPI on the enrollment Practice locations: Cookeville, TN; Crossville, TN; Jamestown, TN; Livingston, TN; McMinnville, TN; Pikeville, TN; Sparta, TN |
| O20141010002188 | TN | DME Supplier - Physician - Ophthalmology |
1355379256 | Practice locations: McMinnville, TN |
National Provider Directory
- Tax ID family
- Eye Centers of Tennessee LL
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | OD3109 | TN | Yes |
| Ophthalmology Physician |
207W00000X | MD16334 | TN | |
| Durable Medical Equipment & Medical Supplies | 332B00000X | MD9365 | TN |
Addresses
Primary practice location
220 N Chancery St
MC Minnville, TN 37110-2551
Mailing address
15 Iris LN
Crossville, TN 38555-7528
Phone (931) 456-2728
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Q008842 | Medicaid | TN |
Other providers in MC Minnville, TN
- David Smedley
- William Glenn Davis
- Dialysis Associates, LLC
- Dva Renal Healthcare, Inc.
- Ernest Mak MD PC
- Timothy Mark Fisher
- Generations Health Assoc. Inc. Dba Generations Mental Health Center
- Generations Health Assoc., Inc Dba Generations Mental Health Ctr
- Generations Health Assoc., Inc. Dba Generations Mental Health Center
- Generations Health Assoication, Inc. Dba Generatrions of McMinnville
All providers in MC Minnville, TN · Optometrist 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.