Healthcare Provider Details

I. General information

NPI: 1841249703
Provider Name (Legal Business Name): SYLVESTER WILLIAM HORA O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 01/04/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 N MAIN ST STE 101B
COLLIERVILLE TN
38017-2650
US

IV. Provider business mailing address

2295 HIGHWAY 196 S
PIPERTON TN
38017-5733
US

V. Phone/Fax

Practice location:
  • Phone: 901-853-1420
  • Fax: 901-853-1421
Mailing address:
  • Phone: 901-486-5211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberODT000810
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: