Healthcare Provider Details

I. General information

NPI: 1912544214
Provider Name (Legal Business Name): WESLEY J. SANDS VISION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2019
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 HIGHWAY 64 E STE 5
WAYNESBORO TN
38485-3050
US

IV. Provider business mailing address

530 HIGHWAY 64 E STE 5
WAYNESBORO TN
38485-3050
US

V. Phone/Fax

Practice location:
  • Phone: 931-722-5009
  • Fax:
Mailing address:
  • Phone: 931-722-5009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: WESLEY J. SANDS
Title or Position: OPTOMERTIST
Credential: OD
Phone: 931-762-1364