Basic Information
| Provider Information | |||||||||
| NPI: | 1609868363 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CAMDEN EYE CARE ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 264 HIGHWAY 641 N | ||||||||
| Address2: | |||||||||
| City: | CAMDEN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383201329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7315847942 | ||||||||
| FaxNumber: | 7315847965 | ||||||||
| Practice Location | |||||||||
| Address1: | 264 HIGHWAY 641 N | ||||||||
| Address2: | |||||||||
| City: | CAMDEN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383201329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7315847942 | ||||||||
| FaxNumber: | 7315847965 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2005 | ||||||||
| LastUpdateDate: | 08/27/2020 | ||||||||
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| AuthorizedOfficialLastName: | REYNOLDSON | ||||||||
| AuthorizedOfficialFirstName: | TONYA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OPTOMETRIST | ||||||||
| AuthorizedOfficialTelephone: | 7315847942 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
| NPICertificationDate: | 08/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OD0000002255 | TN | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 50537 | 01 | TN | DAVIS VISION | OTHER | 7536377 | 01 | TN | AETNA | OTHER | 11494632 | 01 | TN | UNITED HEALTHCARE | OTHER | 3945315 | 05 | TN | MEDICAID | 1012691-0556551 | 01 | TN | BLOCKVISION | OTHER | 4076769 | 01 | TN | TENNCARE SELECT | OTHER | 50537 | 01 | TN | BETTERHEALTH | OTHER | 4076769 | 01 | TN | BLUE CROSS BLUE SHIELD | OTHER | P00193746-DC310 | 01 | TN | RAILROAD MEDICARE | OTHER |