Healthcare Provider Details

I. General information

NPI: 1588664189
Provider Name (Legal Business Name): SILVIA MENDE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1798 ROANE STATE HWY
HARRIMAN TN
37748-8305
US

IV. Provider business mailing address

1275 DICK LONAS RD
KNOXVILLE TN
37909-1382
US

V. Phone/Fax

Practice location:
  • Phone: 800-500-4667
  • Fax: 833-448-2981
Mailing address:
  • Phone: 865-584-4747
  • Fax: 865-381-1509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD1349
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: