Look up the most recent NPI and PECOS records

Music City Eye Care Llc

Optometrist

Eye and Vision Services Providers

1880 N Main St, Shelbyville, TN 37160-2018

PECOS Enrollment

Based on the most recent information from CMS, provider Music City Eye Care Llc does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1841605375
Provider Type
Organization
Full Name
Music City Eye Care Llc

Subpart
No
Enumeration Date
6/23/2014
Last Updated
12/18/2021

Contact Information

Practice Location

1880 N Main St, Shelbyville, TN 37160-2018

(615) 203-9165

Unlisted Fax

Mailing Location

2125 Rock Springs Midland Rd, Christiana, TN 37037-5357

(651) 230-3554

Unlisted Fax

Authorized Official

Johnson, Travis Matthew (Chief)

(615) 203-5037

Provider Taxonomies

Code	Description	License
Code 152W00000X Primary	Description Optometrist Eye and Vision Services Providers	License 3158 Tennessee

Provider Identifiers

ID	Description	Issuer
ID Q005853	Description Medicaid	Issuer Unlisted Tennessee

Music City Eye Care Llc

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Authorized Official

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Dale Hasty

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Keith, Laura Rose

Henderson Gregory, Aundrea Kay

Deharde, John Robert

Hasty, Kenneth D

Grissom, Zeke Parker

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Eye Care Center Associates Pa