| NPI | 1669669107 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY LYNN WEST Office Manager 423-870-3742 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN OD817) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN OD1190) |
| Enumeration Date | 2007-09-28 |
| Last Update Date | 2008-06-30 |