Provider Demographics
NPI:1104871037
Name:EYECARE PLUS CL PLLC
Entity type:Organization
Organization Name:EYECARE PLUS CL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHEYANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-988-5303
Mailing Address - Street 1:2024 WILMA RUDOLPH BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-6620
Mailing Address - Country:US
Mailing Address - Phone:931-551-3031
Mailing Address - Fax:931-552-7488
Practice Address - Street 1:2024 WILMA RUDOLPH BLVD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-6879
Practice Address - Country:US
Practice Address - Phone:931-551-3031
Practice Address - Fax:931-552-7488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2024-04-24
Deactivation Date:2024-02-23
Deactivation Code:
Reactivation Date:2024-04-24
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3722097Medicare PIN
TN4871530001Medicare NSC