Eye M D Ophthalmology PLLC

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

TN MD18870 Issued in TN

Legal business name

EYE M D OPHTHALMOLOGY PLLC

Practice address

926 N Jackson St
Tullahoma, TN 37388-2300

Phone

(931) 393-6004

Fax

(931) 393-4795

NPI assigned

Mar 1, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Ben Bob Mahan, M.D.NPI 1881690311

Title

Owner

Phone

(931) 393-6004

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• MAHAN - RIDLEY PLLC Former legal business name

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ben B Mahan, M.D.

  • Ophthalmology Physician
  • Tullahoma, TN
  • NPI 1881690311
  Medicare reassignment Care Compare group NPD Authorized official
• Sandra T Duckworth, O.D.

  • Optometrist
  • Tullahoma, TN
  • NPI 1427212216
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1503360000000",
    "number": "1407984396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "926 N JACKSON ST",
            "city": "TULLAHOMA",
            "state": "TN",
            "postal_code": "373882300",
            "telephone_number": "931-393-6004",
            "fax_number": "931-393-4795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "926 N JACKSON ST",
            "city": "TULLAHOMA",
            "state": "TN",
            "postal_code": "373882300",
            "telephone_number": "931-393-6004",
            "fax_number": "931-393-4795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE M D OPHTHALMOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-01",
        "last_updated": "2017-08-22",
        "status": "A",
        "authorized_official_last_name": "MAHAN",
        "authorized_official_first_name": "BEN",
        "authorized_official_middle_name": "BOB",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "931-393-6004",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "TN",
            "license": "TN-OD-T394",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "TN",
            "license": "TN MD18870",
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "TN",
            "license": "TN MD 9867",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3711455",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MAHAN - RIDLEY PLLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Elizabeth Leanne Evans, B.A.
• Excel Eyecare PC, Inc
• Expedited Medical Services, LLC
• Eye Associates Optical, LLC.
• Eye Care Center Associates PA
• Eyecare Plus TH PLLC
• Miranda Ezell, LMSW
• Family Practice Center of Tullahoma LLC
• Nicholas Fannin
• Alicia Brooke Fanning, RN

• Ophthalmology Physician in Tullahoma, TN
• Providers in Tullahoma, TN by specialty
• Ophthalmology Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.