NPIMap

Organization Active NPI

Eye Centers of Tennessee, LLC

  • Optometrist
  • McMinnville, TN
National Provider Identifier
1306014378
Registry record updated Apr 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OD3109 Issued in 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
Last updated
Apr 26, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2021

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

Authorized official

Name
Mrs. Tina D Breeding
Title
Front Office Credentialing
Phone
(931) 456-2728

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X OD3109 TN Primary
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 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

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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 - OphthalmologyDME Supplier - OpticianDME Supplier - Physician - Optometrist 1355379256 Practice locations: McMinnville, TN

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
44D2090404Eye Centers of Tennessee220 North Chancery St, MC Minnville, TN 37110Certificate of waiverJan 21, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Eye Centers of Tennessee220 N. Chancery Street, McMinnville, TN 37110-2551(931) 473-2487 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses Accepts assignmentParticipating since Jan 1, 2002

National Provider Directory

National Provider Directory
Tax ID family
Eye CTRS of TN LLC8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1202860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619395200000",
    "number": "1306014378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 IRIS LN",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385557528",
            "telephone_number": "931-456-2728",
            "fax_number": "931-456-5446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 N CHANCERY ST",
            "city": "MC MINNVILLE",
            "state": "TN",
            "postal_code": "371102551",
            "telephone_number": "931-473-2487",
            "fax_number": "931-473-8782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE CENTERS OF TENNESSEE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-13",
        "last_updated": "2021-04-26",
        "certification_date": "2021-04-26",
        "status": "A",
        "authorized_official_last_name": "BREEDING",
        "authorized_official_first_name": "TINA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "FRONT OFFICE CREDENTIALING",
        "authorized_official_telephone_number": "931-456-2728",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "TN",
            "license": "OD3109",
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "TN",
            "license": "MD16334",
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "TN",
            "license": "MD9365",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in McMinnville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2021; 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.