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NPI Code Detail

MEDICARE: JOSHUA DAVID TAYLOR OD

MEDICARE: JOSHUA DAVID TAYLOR OD
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
1152W00000XOptometrist3523TN

General Provider Information

NPI Number : 1700445459
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSHUA DAVID TAYLOR OD
Provider Business Mailing Address
First Line : 2101 FORT HENRY DR SPC E-9
Second Line :
City : KINGSPORT
State : TN
Zip : 37664-3658
Country : US
Telephone Number : 423-246-1585
Fax Number :
Provider Business Practice Location Address
First Line : 2011 N ROAN ST
Second Line :
City : JOHNSON CITY
State : TN
Zip : 37601-3130
Country : US
Telephone Number : 423-610-7155
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2019
Last Update Date : 06/06/2019

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Directions to “ JOSHUA DAVID TAYLOR OD” Practice Location

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