NPIMap

Organization Active NPI

Eye Centers of Tennessee, LLC

  • Optometrist
  • Sparta, TN
National Provider Identifier
1689221970
Registry record updated Oct 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
EYE CENTERS OF TENNESSEE, LLC
Practice address
305 N Spring St
Sparta, TN 38583-1300
Phone
(931) 836-2424
Fax
(931) 836-1314
NPI assigned
Aug 21, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2020

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

Authorized official

Name
Erik Bergvin
Title
Coo
Phone
(931) 456-2728

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X Primary
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X

Addresses

Primary practice location

305 N Spring St
Sparta, TN 38583-1300

Mailing address

15 Iris LN
Crossville, TN 38555-7528
Phone (931) 456-2728

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080826000107 TN Part B Supplier - Clinic/Group Practice 1355379256 Receives reassigned benefits from 17 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cookeville, TN; Crossville, TN; Jamestown, TN; Livingston, TN; McMinnville, TN; Pikeville, TN; Sparta, TN
O20191106003225 TN DME Supplier - Physician - OptometristDME Supplier - Optician 1355379256 Practice locations: Sparta, TN

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D2172163Eye Centers of Tennessee, LLC305 N Spring Street, Sparta, TN 38583Certificate of waiverSep 16, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Eye Centers of Tennessee LLC305 N Spring St, Sparta, TN 38583-1300(931) 836-2424 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses Accepts assignmentParticipating since Jan 1, 2002

National Provider Directory

National Provider Directory
Tax ID family
Eye Centers of Tennessee LL8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

130 S Main St
Sparta, TN 38583
Phone (931) 836-2424

Practitioners & affiliated clinicians

Practitioners 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1566345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603238400000",
    "number": "1689221970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 IRIS LN",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385557528",
            "telephone_number": "931-456-2728",
            "fax_number": "931-456-5446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 N SPRING ST",
            "city": "SPARTA",
            "state": "TN",
            "postal_code": "385831300",
            "telephone_number": "931-836-2424",
            "fax_number": "931-836-1314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE CENTERS OF TENNESSEE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-21",
        "last_updated": "2020-10-21",
        "certification_date": "2020-10-21",
        "status": "A",
        "authorized_official_last_name": "BERGVIN",
        "authorized_official_first_name": "ERIK",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "931-456-2728"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sparta, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2020; 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.