Healthcare Provider Details

I. General information

NPI: 1801729744
Provider Name (Legal Business Name): CARSON PEMBERTON O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3563 TOM AUSTIN HWY
SPRINGFIELD TN
37172-3939
US

IV. Provider business mailing address

3563 TOM AUSTIN HWY
SPRINGFIELD TN
37172-3939
US

V. Phone/Fax

Practice location:
  • Phone: 615-384-5225
  • Fax:
Mailing address:
  • Phone: 615-384-5225
  • Fax: 615-384-1331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4008
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: