Healthcare Provider Details

I. General information

NPI: 1083012181
Provider Name (Legal Business Name): OCULOPLASTIC SPECIALISTS OF TENNESSEE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2014
Last Update Date: 12/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4306 HARDING PIKE SUITE 106
NASHVILLE TN
37205-2205
US

IV. Provider business mailing address

4306 HARDING PIKE SUITE 106
NASHVILLE TN
37205-2205
US

V. Phone/Fax

Practice location:
  • Phone: 615-297-5798
  • Fax: 615-383-6646
Mailing address:
  • Phone: 615-297-5798
  • Fax: 615-383-6646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number017927
License Number StateTN

VIII. Authorized Official

Name: DEBORAH D SHERMAN
Title or Position: PHYSICIAN/ OWNER
Credential: M.D.
Phone: 615-297-5798