Healthcare Provider Details

I. General information

NPI: 1811054232
Provider Name (Legal Business Name): WEST TENNESSEE EYE ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 STONEBRIDGE BLVD
JACKSON TN
38305-2038
US

IV. Provider business mailing address

112 STONEBRIDGE BLVD
JACKSON TN
38305-2038
US

V. Phone/Fax

Practice location:
  • Phone: 731-664-1994
  • Fax: 731-664-2903
Mailing address:
  • Phone: 731-664-1994
  • Fax: 731-664-2903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD1410
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License NumberMD019471
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberMD38610
License Number StateTN

VIII. Authorized Official

Name: SANDY FISH
Title or Position: OFFICE MANAGER
Credential:
Phone: 731-664-1994