| NPI | 1104097815 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAM BROOKS Office Manager 423-929-2020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN 1296) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN 1663) |
| Enumeration Date | 2008-03-20 |
| Last Update Date | 2008-03-20 |