NPIMap

Organization Active NPI

Clarksville Eye Clinic LLC

  • Optometrist
  • Clarksville, TN
National Provider Identifier
1649474263
Registry record updated Apr 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2519 Issued in TN
Legal business name
CLARKSVILLE EYE CLINIC LLC
Practice address
1111A Fort Campbell Blvd
Clarksville, TN 37042
Phone
(931) 645-0346
Fax
(931) 645-0348
NPI assigned
Jun 14, 2007
Last updated
Apr 15, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2019

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

Authorized official

Name
Dr. Matthew Theodore Drew, O.D.NPI 1558387258
Title
Member
Phone
(931) 645-0346

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 2519 TN Primary

Addresses

Primary practice location

1111A Fort Campbell Blvd
Clarksville, TN 37042

Mailing address

1111A Fort Campbell Blvd
Clarksville, TN 37042-6426
Phone (931) 645-0346

Other practice location 1

78 Dover Crossing Rd
Clarksville, TN 37042-4111
Phone (931) 645-0346

National Provider Directory

National Provider Directory

Locations

1111 Fort Campbell Blvd
Ste A
Clarksville, TN 37042

78 Dover Crossing Rd
Clarksville, TN 37042
Phone (931) 645-0346

Practitioners & affiliated clinicians

Practitioners 11

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": "1181779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555286400000",
    "number": "1649474263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111A FORT CAMPBELL BLVD",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370426426",
            "telephone_number": "931-645-0346",
            "fax_number": "931-645-0348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111A FORT CAMPBELL BLVD",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "37042",
            "telephone_number": "931-645-0346",
            "fax_number": "931-645-0348"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "78 Dover Crossing Rd",
            "address_purpose": "LOCATION",
            "city": "Clarksville",
            "state": "TN",
            "postal_code": "370424111",
            "country_code": "US",
            "telephone_number": "931-645-0346",
            "fax_number": "931-645-0348",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CLARKSVILLE EYE CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-14",
        "last_updated": "2019-04-15",
        "status": "A",
        "authorized_official_last_name": "DREW",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "THEODORE",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "931-645-0346",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "TN",
            "license": "2519",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarksville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2019; 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.