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General NPI Number Information
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NPI Number | 1104140508
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Entity Type | Organization
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Legal Business Name | CCN OPTICAL SERVICES LLC
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Dates
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Enumeration Date | 03/15/2010
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Last Update Date | 03/15/2010
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Provider Practice Location Address
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Address Line | 2400 PATTERSON ST #201
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City | NASHVILLE
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State | TN
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Zip | 37203-1562
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Country | US
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Telephone | 615-320-3937
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Fax |
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Provider Business Mailing Address
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Address Line | 2400 PATTERSON ST #201
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City | NASHVILLE
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State | TN
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Zip | 37203-1562
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Country | US
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Telephone | 615-320-3937
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Fax |
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Authorized Official
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Title or Position | OPTICIAN
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Name | HARRY JOSEPH DEMPSEY
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Credential | LDO
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Telephone | 615-320-3937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | MC15763
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License Number State | TN
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