Provider Demographics
NPI:1699961631
Name:BLOUNT COUNTY EYE CENTER, PLLC
Entity type:Organization
Organization Name:BLOUNT COUNTY EYE CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:DUVALL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:865-982-6761
Mailing Address - Street 1:702 S FOOTHILLS PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801-2300
Mailing Address - Country:US
Mailing Address - Phone:865-982-6761
Mailing Address - Fax:865-982-7402
Practice Address - Street 1:1732 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-5510
Practice Address - Country:US
Practice Address - Phone:865-982-6761
Practice Address - Fax:865-982-7402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT694152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT61175Medicare UPIN