Basic Information
| Provider Information | |||||||||
| NPI: | 1427003052 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EYE SURGERY CENTER OF NASHVILLE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14201 DALLAS PKWY | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752542916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727633859 | ||||||||
| FaxNumber: | 9729203445 | ||||||||
| Practice Location | |||||||||
| Address1: | 310 25TH AVE N | ||||||||
| Address2: | STE 105 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372031515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153299023 | ||||||||
| FaxNumber: | 6153291665 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 04/07/2021 | ||||||||
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| AuthorizedOfficialLastName: | O'CONNOR | ||||||||
| AuthorizedOfficialFirstName: | KRISTEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICER/AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 6153767315 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 0000000013 | TN | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | 3288598 | 05 | TN | MEDICAID | 490005354 | 01 | TN | RAILROAD MEDICARE | OTHER |