Healthcare Provider Details

I. General information

NPI: 1972754901
Provider Name (Legal Business Name): DAVID L FOUTCH OD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2008
Last Update Date: 05/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2585 NASHVILLE HWY
SMITHVILLE TN
37166-7259
US

IV. Provider business mailing address

2585 NASHVILLE HWY
SMITHVILLE TN
37166-7259
US

V. Phone/Fax

Practice location:
  • Phone: 615-597-2255
  • Fax: 615-597-2257
Mailing address:
  • Phone: 615-597-2255
  • Fax: 615-597-2257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberODT1164
License Number StateTN

VIII. Authorized Official

Name: DR. DAVID L FOUTCH
Title or Position: OWNER
Credential: OD PC
Phone: 615-597-2255