Healthcare Provider Details

I. General information

NPI: 1275702045
Provider Name (Legal Business Name): CLAYTON B RHODES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5433 HIXSON PIKE
HIXSON TN
37343-3238
US

IV. Provider business mailing address

5433 HIXSON PIKE
HIXSON TN
37343-3238
US

V. Phone/Fax

Practice location:
  • Phone: 423-843-2020
  • Fax: 423-842-1914
Mailing address:
  • Phone: 423-843-2020
  • Fax: 423-842-1914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD507
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: CLAYTON B RHODES
Title or Position: OD
Credential: OD
Phone: 423-843-2020