NPIMap

Organization Active NPI

Northshore Specialty Eyecare PLLC

  • Optometrist
  • Knoxville, TN
National Provider Identifier
1790320174
Registry record updated Nov 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
NORTHSHORE SPECIALTY EYECARE PLLC
Practice address
2053 Thunderhead Rd
Knoxville, TN 37922-9488
Phone
(865) 288-4449
NPI assigned
Nov 9, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2019

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

Authorized official

Name
Dr. Susan Carter, ODNPI 1538577747
Title
Owner
Phone
(423) 677-9089

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

2053 Thunderhead Rd
Knoxville, TN 37922-9488

Mailing address

2053 Thunderhead Rd
Knoxville, TN 37922-9488
Phone (865) 288-4449

Other names 1

  • eyes on northshore Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200122002419 TN Part B Supplier - Clinic/Group Practice 2668807595 Receives reassigned benefits from 2 practitioners
Practice locations: Knoxville, TN

National Provider Directory

National Provider Directory
Tax ID family
Eyes on Northshore2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

2053 Thunderhead Rd
Knoxville, TN 37922
Phone (865) 288-4449

Practitioners & affiliated clinicians

Practitioners 2

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": "1573257600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1573257600000",
    "number": "1790320174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2053 THUNDERHEAD RD",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379229488",
            "telephone_number": "865-288-4449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2053 THUNDERHEAD RD",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379229488",
            "telephone_number": "865-288-4449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSHORE SPECIALTY EYECARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-09",
        "last_updated": "2019-11-09",
        "status": "A",
        "authorized_official_last_name": "CARTER",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "423-677-9089",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "eyes on northshore",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Nov 9, 2019; 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.