| NPI | 1902920507 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA D BREEDING Front Office Credentialing 931-456-2728 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 156FX1800X Technician/Technologist, Optician |
| 207W00000X Ophthalmology | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: TN OD723) | |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2021-04-26 |