Provider Demographics
NPI:1730251323
Name:NURSING HOME EYECARE PLLC
Entity type:Organization
Organization Name:NURSING HOME EYECARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JARROD
Authorized Official - Middle Name:
Authorized Official - Last Name:PEACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-598-0142
Mailing Address - Street 1:1130 HIGHWAY 96 N
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:TN
Mailing Address - Zip Code:37062-2804
Mailing Address - Country:US
Mailing Address - Phone:615-734-9771
Mailing Address - Fax:615-799-6010
Practice Address - Street 1:1130 HIGHWAY 96 N
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:TN
Practice Address - Zip Code:37062-2804
Practice Address - Country:US
Practice Address - Phone:615-734-9771
Practice Address - Fax:615-799-6010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2531152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3733419Medicare PIN