Healthcare Provider Details

I. General information

NPI: 1629724935
Provider Name (Legal Business Name): OCULOPLASTIC SPECIALISTS OF TENNESSEE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2022
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4306 HARDING PIKE STE 106
NASHVILLE TN
37205-2249
US

IV. Provider business mailing address

4306 HARDING PIKE STE 106
NASHVILLE TN
37205-2249
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY SIKTBERG
Title or Position: BUSINESS MANAGER
Credential:
Phone: 615-400-5844