Provider Demographics
NPI:1316199037
Name:MODERN EYECARE CENTER, LLC
Entity type:Organization
Organization Name:MODERN EYECARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCAFEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-486-9992
Mailing Address - Street 1:1027 CROSSINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-2776
Mailing Address - Country:US
Mailing Address - Phone:931-486-9992
Mailing Address - Fax:931-486-9993
Practice Address - Street 1:1027 CROSSINGS BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-2776
Practice Address - Country:US
Practice Address - Phone:931-486-9992
Practice Address - Fax:931-486-9993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-13
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1920152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU72763Medicare UPIN
6166000001Medicare NSC
39421001Medicare PIN