Healthcare Provider Details

I. General information

NPI: 1407025968
Provider Name (Legal Business Name): TAMMY HOLSCLAW-JONES OD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 ROGOSIN DR.
ELIZABETHTON TN
37643
US

IV. Provider business mailing address

210 ROGOSIN DR.
ELIZABETHTON TN
37643
US

V. Phone/Fax

Practice location:
  • Phone: 423-543-6868
  • Fax: 423-543-4226
Mailing address:
  • Phone: 423-543-6868
  • Fax: 423-543-4226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberODT0000001180
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. TAMMY L. HOLSCLAW-JONES
Title or Position: OPTOMETRIST
Credential:
Phone: 423-543-6868