MEDICARE: CULLISON EYE CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2365	TN

General Provider Information

NPI Number	:	1578944674
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CULLISON EYE CARE

Provider Business Mailing Address
First Line	:	2059 S HOUSTON LEVEE RD
Second Line	:	SUITE #125
City	:	GERMANTOWN
State	:	TN
Zip	:	38139-6970
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2059 S HOUSTON LEVEE RD
Second Line	:	SUITE #125
City	:	GERMANTOWN
State	:	TN
Zip	:	38139-6970
Country	:	US
Telephone Number	:	901-850-8572
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. CHAD CULLISON
Credential	:
Telephone Number	:	901-850-8572

Provider Enumeration Date	:	06/15/2015
Last Update Date	:	06/15/2015

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