Provider Demographics
NPI:1982802559
Name:SOUTHERN TENNESSEE EYE SPECIALISTS INC.
Entity type:Organization
Organization Name:SOUTHERN TENNESSEE EYE SPECIALISTS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:KAVOUSSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-854-6220
Mailing Address - Street 1:336 POPLAR VIEW PKWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-3436
Mailing Address - Country:US
Mailing Address - Phone:901-854-6220
Mailing Address - Fax:901-854-6808
Practice Address - Street 1:336 POPLAR VIEW PKWY
Practice Address - Street 2:SUITE 1
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-3436
Practice Address - Country:US
Practice Address - Phone:901-854-6220
Practice Address - Fax:901-854-6808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12179207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1982802559OtherGROUP NPI
TN1871694877OtherPERSONAL NPI NUMBER
TNA51371Medicare UPIN
TN3380282Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER
TN1871694877OtherPERSONAL NPI NUMBER