Provider Demographics
NPI:1316064983
Name:EXCEL EYECARE PC, INC
Entity type:Organization
Organization Name:EXCEL EYECARE PC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:ROBERTS
Authorized Official - Last Name:SOHRABI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:931-455-5554
Mailing Address - Street 1:PO BOX 2014
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-2014
Mailing Address - Country:US
Mailing Address - Phone:931-455-5554
Mailing Address - Fax:931-455-3331
Practice Address - Street 1:921 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-2313
Practice Address - Country:US
Practice Address - Phone:931-455-5554
Practice Address - Fax:931-455-3331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2427152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3727111Medicare PIN
TN5865410001Medicare NSC