Healthcare Provider Details

I. General information

NPI: 1588188650
Provider Name (Legal Business Name): TIMOTHY HUNTER FOUTCH OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 08/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2585 NASHVILLE HWY
SMITHVILLE TN
37166-7259
US

IV. Provider business mailing address

12000 NASHVILLE HWY
LIBERTY TN
37095-3567
US

V. Phone/Fax

Practice location:
  • Phone: 615-597-2255
  • Fax:
Mailing address:
  • Phone: 615-785-4622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3393
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: