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General NPI Number Information
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NPI Number | 1033383310
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Entity Type | Organization
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Legal Business Name | GODSEY ENTERPRISES INC
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Dates
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Enumeration Date | 04/17/2008
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Last Update Date | 05/06/2008
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Provider Practice Location Address
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Address Line | 111 BROYLES ST
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City | JOHNSON CITY
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State | TN
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Zip | 37601-2532
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Country | US
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Telephone | 423-282-1932
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Fax | 423-282-8813
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Provider Business Mailing Address
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Address Line | 111 BROYLES ST
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City | JOHNSON CITY
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State | TN
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Zip | 37601-2532
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Country | US
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Telephone | 423-282-1932
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Fax | 423-282-8813
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Authorized Official
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Title or Position | OWNER
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Name | KELLY GODSEY
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Credential |
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Telephone | 423-282-1932
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | DPO174
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License Number State | TN
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