| NPI | 1306014378 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA D BREEDING Front Office Credentialing 931-456-2728 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN OD3109) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TN MD16334) |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: TN MD9365) | |
| Enumeration Date | 2008-02-13 |
| Last Update Date | 2021-04-26 |