Healthcare Provider Details

I. General information

NPI: 1528017050
Provider Name (Legal Business Name): MIKE HASSELL O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MICHAEL R. HASSELL O.D.

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 MAIN ST N
CARTHAGE TN
37030-1211
US

IV. Provider business mailing address

PO BOX 116
CARTHAGE TN
37030-0116
US

V. Phone/Fax

Practice location:
  • Phone: 615-735-2020
  • Fax: 615-735-9098
Mailing address:
  • Phone: 615-735-2020
  • Fax: 615-735-9098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD0000000889
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: