Provider Demographics
NPI:1538787361
Name:EYE SURGERY CENTER OF MORRISTOWN, LLC
Entity type:Organization
Organization Name:EYE SURGERY CENTER OF MORRISTOWN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER/EXEC DIR.
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:RUDOLPH
Authorized Official - Suffix:SR
Authorized Official - Credentials:CPA
Authorized Official - Phone:423-690-2600
Mailing Address - Street 1:448 N. CEDAR BLUFF RD STE 255
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-3612
Mailing Address - Country:US
Mailing Address - Phone:423-690-2600
Mailing Address - Fax:423-690-2601
Practice Address - Street 1:1639 W MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-2832
Practice Address - Country:US
Practice Address - Phone:423-690-2600
Practice Address - Fax:423-690-2601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-08
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical