Basic Information
| Provider Information | |||||||||
| NPI: | 1700131752 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EYECARE EAST, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9031 VALLEY CREST LN | ||||||||
| Address2: | |||||||||
| City: | GERMANTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381387829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9017572020 | ||||||||
| FaxNumber: | 9017512399 | ||||||||
| Practice Location | |||||||||
| Address1: | 9031 VALLEY CREST LN | ||||||||
| Address2: | |||||||||
| City: | GERMANTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381387829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9017572020 | ||||||||
| FaxNumber: | 9017512399 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2012 | ||||||||
| LastUpdateDate: | 05/24/2021 | ||||||||
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| AuthorizedOfficialLastName: | MORMON | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | DARWIN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9017572020 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
| NPICertificationDate: | 05/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 2254 | TN | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.