Basic Information
| Provider Information | |||||||||
| NPI: | 1073524096 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | UNIVERSITY EYE SPECIALISTS, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1932 ALCOA HWY STE 255 | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8652442020 | ||||||||
| FaxNumber: | 8654107292 | ||||||||
| Practice Location | |||||||||
| Address1: | 622 SMITHVIEW DR | ||||||||
| Address2: | |||||||||
| City: | MARYVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378036100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8656811234 | ||||||||
| FaxNumber: | 8659829746 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2006 | ||||||||
| LastUpdateDate: | 06/05/2017 | ||||||||
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| AuthorizedOfficialLastName: | PITT | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8652442020 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332H00000X | Y | Suppliers | Eyewear Supplier (Equipment, not the service) |
ID Information
| ID | Type | State | Issuer | Description | 0727320003 | 01 | DMERC - MVO | OTHER |