Healthcare Provider Details

I. General information

NPI: 1417613787
Provider Name (Legal Business Name): TN DOCTORS OF OPTOMETRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2021
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 VANN DRIVE
JACKSON TN
38305-6001
US

IV. Provider business mailing address

175 E HOUSTON STREET
SAN ANTONIO TX
78205-2255
US

V. Phone/Fax

Practice location:
  • Phone: 731-668-3806
  • Fax: 731-668-3807
Mailing address:
  • Phone: 800-340-0129
  • Fax: 210-524-6587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DOLSIE MCDONALD
Title or Position: MANAGER
Credential:
Phone: 726-444-4078