Healthcare Provider Details

I. General information

NPI: 1205740917
Provider Name (Legal Business Name): HEATHER LYNN VARDELL-KNAUF DPO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 ROBERTS ST
FRANKLIN TN
37064-3126
US

IV. Provider business mailing address

400 ROBERTS ST
FRANKLIN TN
37064-3126
US

V. Phone/Fax

Practice location:
  • Phone: 615-336-8109
  • Fax:
Mailing address:
  • Phone: 615-336-8109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number2057
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: