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General NPI Number Information
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NPI Number | 1013062298
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Entity Type | Organization
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Legal Business Name | MBC INC
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 01/24/2008
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Provider Practice Location Address
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Address Line | 7085 HIGHWAY 64 SUITE 2
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City | OAKLAND
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State | TN
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Zip | 38060-3366
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Country | US
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Telephone | 901-466-1333
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Fax | 901-466-1333
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Provider Business Mailing Address
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Address Line | 7085 HIGHWAY 64 SUITE 2
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City | OAKLAND
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State | TN
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Zip | 38060-3366
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Country | US
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Telephone | 901-466-1333
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Fax | 901-466-1333
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Authorized Official
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Title or Position | OWNER
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Name | DR. WESLEY ONEAL PERSELL
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Credential | O.D.
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Telephone | 901-466-1333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2443
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License Number State | TN
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