Healthcare Provider Details

I. General information

NPI: 1710928908
Provider Name (Legal Business Name): GEORGE HAROLD LLOYD JR. OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 06/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 CEDAR AVE
SOUTH PITTSBURG TN
37380
US

IV. Provider business mailing address

PO BOX 229 233 CEDAR AVE
SOUTH PITTSBURG TN
37380
US

V. Phone/Fax

Practice location:
  • Phone: 423-837-8611
  • Fax: 423-837-8612
Mailing address:
  • Phone: 423-837-8611
  • Fax: 423-837-8612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberODT860
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: