Modern Eye Gallery

Primary specialty

OptometristTaxonomy code 152W00000X

License

OD 2759 Issued in TN

Legal business name

MODERN EYE GALLERY

Practice address

12904 Lebanon Rd
Mount Juliet, TN 37122-2865

Phone

(615) 450-0050

NPI assigned

Jun 10, 2016

Organization subpart

No

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

Authorized official

Name

John KirbyNPI 1437358959

Title

Sole MBR

Phone

(615) 450-0050

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

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

• John Allen Kirby, O.D.

  • Optometrist
  • Mount Juliet, TN
  • NPI 1437358959
  NPD (past) Authorized official

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

{
    "created_epoch": "1465516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465516800000",
    "number": "1558710426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12904 LEBANON RD",
            "city": "MOUNT JULIET",
            "state": "TN",
            "postal_code": "371222865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12904 LEBANON RD",
            "city": "MOUNT JULIET",
            "state": "TN",
            "postal_code": "371222865",
            "telephone_number": "615-450-0050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN EYE GALLERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-10",
        "last_updated": "2016-06-10",
        "status": "A",
        "authorized_official_last_name": "KIRBY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "SOLE MBR",
        "authorized_official_telephone_number": "615-450-0050"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "TN",
            "license": "OD 2759",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1523521",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mica Erin Carter Mitchell, SLP
• MMDS of Nashville Idtf LLC
• MMDS of Nashville, LLC
• Mobile Wound Care Services - Southeast PC
• Reginald Mobley
• Deena Montgomery, FNP-C
• Candace Mooney, MS RDN CSR LDN
• Kristina Moore
• Laura Moore, PHARMD
• Raven Moore

• Optometrist in Mount Juliet, TN
• Providers in Mount Juliet, TN by specialty
• Optometrist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.