Healthcare Provider Details

I. General information

NPI: 1518645183
Provider Name (Legal Business Name): OLEN THOMAS TATHAM III OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2023
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1196 SKYLAND DR
SYLVA NC
28779-8002
US

IV. Provider business mailing address

8 MEDICAL PARK DR
ASHEVILLE NC
28803-2493
US

V. Phone/Fax

Practice location:
  • Phone: 828-258-1586
  • Fax: 828-210-0962
Mailing address:
  • Phone: 828-258-1586
  • Fax: 828-210-0962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2429
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2769
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: