Healthcare Provider Details

I. General information

NPI: 1740583913
Provider Name (Legal Business Name): NOLENSVILLE FAMILY EYECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2010
Last Update Date: 12/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7177 NOLENSVILLE RD STE A3
NOLENSVILLE TN
37135-9597
US

IV. Provider business mailing address

7177 NOLENSVILLE RD STE A3
NOLENSVILLE TN
37135-9597
US

V. Phone/Fax

Practice location:
  • Phone: 615-815-1632
  • Fax:
Mailing address:
  • Phone: 615-815-1632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2921
License Number StateTN

VIII. Authorized Official

Name: DR. PHILLIP DANIEL HAYES
Title or Position: OWNER
Credential: O.D.
Phone: 615-788-9775