Provider Demographics
NPI:1871610139
Name:NORTHWEST TENNESSEE EYE CLINIC, PC
Entity type:Organization
Organization Name:NORTHWEST TENNESSEE EYE CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-587-2022
Mailing Address - Street 1:111 HIGHWAY 431
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237-8264
Mailing Address - Country:US
Mailing Address - Phone:731-587-2022
Mailing Address - Fax:731-587-9397
Practice Address - Street 1:111 HIGHWAY 431
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38237-8264
Practice Address - Country:US
Practice Address - Phone:731-587-2022
Practice Address - Fax:731-587-9397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN1767261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3590029Medicaid
TN410033713OtherRAILROAD MEDICARE
TN35900291Medicare PIN
TN3590029Medicaid
TN410033713OtherRAILROAD MEDICARE