Provider Demographics
NPI:1174972913
Name:EYES ON DIABETES PLLC
Entity type:Organization
Organization Name:EYES ON DIABETES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:
Authorized Official - Last Name:LUMPKIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:731-676-2028
Mailing Address - Street 1:215 HOLLY LN
Mailing Address - Street 2:#A
Mailing Address - City:WAVERLY
Mailing Address - State:TN
Mailing Address - Zip Code:37185-3387
Mailing Address - Country:US
Mailing Address - Phone:931-296-1990
Mailing Address - Fax:931-296-1889
Practice Address - Street 1:215 HOLLY LN
Practice Address - Street 2:#A
Practice Address - City:WAVERLY
Practice Address - State:TN
Practice Address - Zip Code:37185-3387
Practice Address - Country:US
Practice Address - Phone:931-296-1990
Practice Address - Fax:931-296-1889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-10
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty