Basic Information
| Provider Information | |||||||||
| NPI: | 1568622413 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KNOXVILLE OPHTHALMOLOGY ASC, LLC | ||||||||
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| OtherOrganizationName: | EYE SURGERY CENTER OF EAST TENNESSEE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1A BURTON HILLS BLVD | ||||||||
| Address2: | ATTN: L&C | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372156103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655881037 | ||||||||
| FaxNumber: | 8659099104 | ||||||||
| Practice Location | |||||||||
| Address1: | 1124 E WEISGARBER RD STE 110 | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379092600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655881037 | ||||||||
| FaxNumber: | 8659099104 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2008 | ||||||||
| LastUpdateDate: | 03/16/2022 | ||||||||
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| AuthorizedOfficialLastName: | SIMMONS | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6156651283 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 03/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.