NPIMap

Organization Active NPI

Rogersville Vision Clinic, PLLC

  • Optometrist
  • Knoxville, TN
National Provider Identifier
1699834564
Registry record updated Apr 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
ODT738 Issued in TN
Legal business name
ROGERSVILLE VISION CLINIC, PLLC
Practice address
2020 Chapman Hwy
Suite 1
Knoxville, TN 37920-1964
Phone
(865) 573-2443
Fax
(865) 573-3703
NPI assigned
Dec 7, 2006
Organization subpart
Yes
Parent organization
ROGERSVILLE VISION CLINIC, PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 18, 2011

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

Authorized official

Name
Mr. Eddie H Abernathy Jr., OPTOMETRIST
Title
Owner
Phone
(865) 573-2443

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X ODT738 TN Primary

Addresses

Primary practice location

2020 Chapman Hwy
Suite 1
Knoxville, TN 37920-1964

Mailing address

2020 Chapman Hwy
Suite 1
Knoxville, TN 37920-1964
Phone (865) 573-2443

Other identifiers 2

IdentifierTypeStateIssuer
A04960OtherTNEYEMED
62413OtherAVESIS

Other names 1

  • TAPP OPTICAL Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110421000225 TN DME Supplier - Physician - Optometrist 5395894224 Practice locations: Knoxville, TN

Other NPIs with the same Medicare PAC ID 1

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

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.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Rogersville Vision Clinic, PLLC2020 Chapman Hwy, Knoxville, TN 37920-2082(865) 573-2443 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Apr 8, 2009

National Provider Directory

National Provider Directory
Tax ID family
Rogersville Vision Clinicpllc2 organizations share this tax ID, including this one
Part of
Rogersville Vision Clinicpllc

Other organizations with this tax ID 1

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

Locations

2020 Chapman Hwy
Ste 1
Knoxville, TN 37920
Phone (865) 573-2443

1818 US Highway 23 North
Weber City, VA 24290

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 8

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

NPI Registry JSON

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

{
    "created_epoch": "1165449600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303084800000",
    "number": "1699834564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 CHAPMAN HWY",
            "address_2": "SUITE 1",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379201964",
            "telephone_number": "865-573-2443",
            "fax_number": "865-573-3703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 CHAPMAN HWY",
            "address_2": "SUITE 1",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379201964",
            "telephone_number": "865-573-2443",
            "fax_number": "865-573-3703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROGERSVILLE VISION CLINIC, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ROGERSVILLE VISION CLINIC, PLLC",
        "enumeration_date": "2006-12-07",
        "last_updated": "2011-04-18",
        "status": "A",
        "authorized_official_last_name": "ABERNATHY",
        "authorized_official_first_name": "EDDIE",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "865-573-2443",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "OPTOMETRIST"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "TN",
            "license": "ODT738",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED",
            "identifier": "A04960",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AVESIS",
            "identifier": "62413",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TAPP OPTICAL",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Knoxville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2011; 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.