Eye Surgery Center of Lenoir City, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

EYE SURGERY CENTER OF LENOIR CITY, LLC

Practice address

5491 Creekwood Park Blvd Ste B
Lenoir City, TN 37772-1204

Phone

(865) 328-7400

Fax

(865) 317-1270

NPI assigned

Mar 20, 2019

Organization subpart

No

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

Authorized official

Name

Mr. Stephen H Rudolph Sr., CPA

Title

Chief Operating Officer

Phone

(865) 328-7400

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Listed as

Eye Surgery Center of Lenoir City LLCCCN 44C0001198

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1553040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626998400000",
    "number": "1326508045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5491 CREEKWOOD PARK BLVD STE B",
            "city": "LENOIR CITY",
            "state": "TN",
            "postal_code": "377721204",
            "telephone_number": "865-635-4545",
            "fax_number": "865-317-1270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5491 CREEKWOOD PARK BLVD STE B",
            "city": "LENOIR CITY",
            "state": "TN",
            "postal_code": "377721204",
            "telephone_number": "865-328-7400",
            "fax_number": "865-317-1270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE SURGERY CENTER OF LENOIR CITY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-20",
        "last_updated": "2021-07-23",
        "certification_date": "2021-07-23",
        "status": "A",
        "authorized_official_last_name": "RUDOLPH",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "865-328-7400",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathleen Webster Erickson, LCSW
• Leanna Marie Estes
• Noel Lee Evans, ATC
• Evolve 865
• Eye Care Centers PLLC (Lenoir City Eye Center)
• Matthew Edward Fearrington, PH.D.
• Spencer Alexander Ferenczy, PA-C
• Amy Janel Fitzsimmons, BS
• Winston Fleming, PT, DPT
• Thyra Lynn Folkard

• Ambulatory Surgical Clinic/Center in Lenoir City, TN
• Providers in Lenoir City, TN by specialty
• Ambulatory Surgical Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 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.