Lisa M Ely, O.D.08
Individual provider Active NPI Optometrist · Clarksville, TN
NPI 1396793576 · NPPES record last updated Oct 14, 2014
Key facts
- NPI
- 1396793576
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 2386 (TN)
- Practice address
- 3315 Guthrie Hwy
Clarksville, TN 37040-5507 - Phone
- (931) 647-3208
- Fax
- (931) 552-8732
- NPI assigned
- May 4, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
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 |
|---|---|---|---|---|
| I20060622000018 | TN | Practitioner - Optometry | 6406868140 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2386 | TN | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| All Eyes Vision Care, Inc. | Optometrist | Current |
Accepting new patients |
Locations
3315 Guthrie Hwy
Clarksville, TN 37040
Phone (931) 552-4602
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2386 | TN | Yes |
Addresses
Primary practice location
3315 Guthrie Hwy
Clarksville, TN 37040-5507
Mailing address
115 Alexander Blvd
Clarksville, TN 37040-5145
Phone (931) 647-3208
Other names
- Dr. Lisa M Dye
Other providers in Clarksville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 14, 2014. 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.