1437815651 NPI number — TN DOCTORS OF OPTOMETRY, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437815651 NPI number — TN DOCTORS OF OPTOMETRY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TN DOCTORS OF OPTOMETRY, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
VISIONWORKS DOCTORS OF OPTOMETRY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437815651
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
175 E HOUSTON STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78205-2255
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-340-0129
Provider Business Mailing Address Fax Number:
210-524-6587

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5307 HIGHWAY 153
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
HIXSON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37343-4912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-877-3309
Provider Business Practice Location Address Fax Number:
423-877-3310
Provider Enumeration Date:
11/11/2021

Additional Information

Authorized Official

Authorized Official Last Name:
MCDONALD
Authorized Official First Name:
DOLSIE
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
726-444-4078

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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