Provider Demographics
NPI:1962053363
Name:MUSIC CITY EYE CARE LLC
Entity type:Organization
Organization Name:MUSIC CITY EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:615-203-5037
Mailing Address - Street 1:1720 OLD FORT PKWY STE C160
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-6305
Mailing Address - Country:US
Mailing Address - Phone:651-230-3554
Mailing Address - Fax:
Practice Address - Street 1:1720 OLD FORT PKWY STE C160
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-6305
Practice Address - Country:US
Practice Address - Phone:651-230-3554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MUSIC CITY EYE CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-26
Last Update Date:2021-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ005853Medicaid