Healthcare Provider Details

I. General information

NPI: 1972520807
Provider Name (Legal Business Name): CAROL P. LAGRANGE, O.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 08/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2043 GREYSTONE PARK
JACKSON TN
38305-3575
US

IV. Provider business mailing address

2043 GREYSTONE PARK
JACKSON TN
38305-3575
US

V. Phone/Fax

Practice location:
  • Phone: 731-668-3424
  • Fax: 731-668-3425
Mailing address:
  • Phone: 731-668-3424
  • Fax: 731-668-3425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberODT831
License Number StateTN

VIII. Authorized Official

Name: DR. STEPHANIE PHILLIPS LAYMAN
Title or Position: OWNER
Credential: O.D.
Phone: 731-668-3424