Provider Demographics
NPI:1336230077
Name:ASSOCIATES IN EYE CARE, INC.
Entity type:Organization
Organization Name:ASSOCIATES IN EYE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:UPCHURCH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:606-387-5612
Mailing Address - Street 1:PO BOX 306
Mailing Address - Street 2:
Mailing Address - City:FERGUSON
Mailing Address - State:KY
Mailing Address - Zip Code:42533-0306
Mailing Address - Country:US
Mailing Address - Phone:606-492-2211
Mailing Address - Fax:606-676-0873
Practice Address - Street 1:2523 JACKSBORO PK
Practice Address - Street 2:
Practice Address - City:JACKSBORO
Practice Address - State:TN
Practice Address - Zip Code:37757-4847
Practice Address - Country:US
Practice Address - Phone:423-566-2020
Practice Address - Fax:423-566-4245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN174791OtherBCBSTN/BLUECARE/TENNCARE
TN3942271OtherMEDICAID # FOR DR. SANDY MYSLIWIEC
TN3941347Medicaid
TN3941367; 3941363OtherMEDICARE PIN FOR DR. KEVIN MYSLIWIEC
CO0230:012OtherEYEMED
TN3941367; 3941363OtherMEDICAID # FOR DR. KEVIN MYSLIWIEC
62081OtherOPTUMHEALTH VISION
TNCJ5379OtherRAILROAD MEDICARE
TN3942271OtherMEDICARE PIN FOR DR. SANDY MYSLIWIEC
TN3942271OtherMEDICARE PIN FOR DR. SANDY MYSLIWIEC
TN3942271OtherMEDICAID # FOR DR. SANDY MYSLIWIEC
TNU67981Medicare UPIN
TN3941347Medicaid
TN3941347Medicare PIN