Basic Information
| Provider Information | |||||||||
| NPI: | 1750942363 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FAYETTE EYE ASSOCIATES PLLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | FAYETTE FAMILY VISION CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3161 HIGHWAY 64 STE 500 | ||||||||
| Address2: | |||||||||
| City: | EADS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380283370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9014653130 | ||||||||
| FaxNumber: | 9012340133 | ||||||||
| Practice Location | |||||||||
| Address1: | 3161 HIGHWAY 64 STE 500 | ||||||||
| Address2: | |||||||||
| City: | EADS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380283370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9014653130 | ||||||||
| FaxNumber: | 9012340133 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2019 | ||||||||
| LastUpdateDate: | 05/24/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HOWELL | ||||||||
| AuthorizedOfficialFirstName: | SHEILA | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING AND CONTRACTING | ||||||||
| AuthorizedOfficialTelephone: | 9017572020 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.