Healthcare Provider Details

I. General information

NPI: 1063113223
Provider Name (Legal Business Name): CARA ENFINGER LDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2944 HIGHWAY 31 W STE 101
WHITE HOUSE TN
37188-3003
US

IV. Provider business mailing address

555 FERN VALLEY RD
WHITE HOUSE TN
37188-4104
US

V. Phone/Fax

Practice location:
  • Phone: 850-313-3367
  • Fax:
Mailing address:
  • Phone: 850-313-3367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberDO3106
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: