Provider Demographics
NPI:1104968817
Name:COOL SPRINGS EYECARE, PLLC
Entity type:Organization
Organization Name:COOL SPRINGS EYECARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:KEGARISE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:615-771-7555
Mailing Address - Street 1:3252 ASPEN GROVE DRIVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-7215
Mailing Address - Country:US
Mailing Address - Phone:615-771-7555
Mailing Address - Fax:615-771-7773
Practice Address - Street 1:3252 ASPEN GROVE DRIVE
Practice Address - Street 2:SUITE 1
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-7215
Practice Address - Country:US
Practice Address - Phone:615-771-7555
Practice Address - Fax:615-771-7773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN152W00000X152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN410043931OtherRAILROAD MEDICARE
TN3943784Medicaid
TN3949200001Medicare NSC
TN3943784Medicaid
TN410043931OtherRAILROAD MEDICARE