Healthcare Provider Details

I. General information

NPI: 1700816949
Provider Name (Legal Business Name): FAIRBANKS OCULAR PROSTHETICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 WEST END AVE SUITE 402
NASHVILLE TN
37203
US

IV. Provider business mailing address

1720 WEST END AVE SUITE 402
NASHVILLE TN
37203
US

V. Phone/Fax

Practice location:
  • Phone: 615-322-9940
  • Fax: 615-320-0970
Mailing address:
  • Phone: 615-322-9940
  • Fax: 615-320-0970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1700X
TaxonomyOcularist
License Number05-311-11
License Number StateTN

VIII. Authorized Official

Name: MR. STEPHEN E SANDERS
Title or Position: PRESIDENT
Credential: B.C.O., BADO
Phone: 615-322-9940