| Fayette Eye Associates Pllc | |
|
3161 Highway 64 Ste 500 Eads TN 38028-3370 | |
| (901) 465-3130 | |
| (901) 234-0133 |
| Full Name | Fayette Eye Associates Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3161 Highway 64 Ste 500, Eads, Tennessee |
| Authorized Official Name and Position | Sheila S Howell (CREDENTIALING AND CONTRACTING) |
| Authorized Official Contact | 9017572020 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fayette Eye Associates Pllc 3161 Highway 64 Ste 500 Eads TN 38028-3370 Ph: (901) 465-3130 | Fayette Eye Associates Pllc 3161 Highway 64 Ste 500 Eads TN 38028-3370 Ph: (901) 465-3130 |
| NPI Number | 1750942363 |
|---|---|
| Provider Enumeration Date | 06/25/2019 |
| Last Update Date | 05/24/2021 |
| Medicare PECOS PAC ID | 2567886062 |
|---|---|
| Medicare Enrollment ID | O20200716002525 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750942363 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Paul Darwin Mormon |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1699768887 PECOS PAC ID: 7517926082 Enrollment ID: I20041008001145 |
| Provider Name | David C. Haba |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1720500218 PECOS PAC ID: 3476812314 Enrollment ID: I20180122002376 |
| Provider Name | Aubrey L Long |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1073175329 PECOS PAC ID: 1052641214 Enrollment ID: I20191001002843 |
| Provider Name | Ty H Smith |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1992282529 PECOS PAC ID: 7911241773 Enrollment ID: I20210706001054 |
| Provider Name | Alice Hanson |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1447944335 PECOS PAC ID: 1052770260 Enrollment ID: I20230706002464 |