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General NPI Number Information
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NPI Number | 1194920967
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Entity Type | Organization
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Legal Business Name | DRS. TIDWELL, FAULKS, AND ALLEN - OPTOMETRY, PLLC
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Dates
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Enumeration Date | 06/20/2007
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 610 HENSLEE DR
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City | DICKSON
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State | TN
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Zip | 37055-1211
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Country | US
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Telephone | 615-446-2020
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Fax | 615-441-2020
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Provider Business Mailing Address
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Address Line | 610 HENSLEE DR
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City | DICKSON
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State | TN
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Zip | 37055-1211
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Country | US
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Telephone | 615-446-2020
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Fax | 615-441-2020
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Authorized Official
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Title or Position | CERTIFIED INSURANCE TECH AND DATA E
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Name | JAMIE LEIGH MILLER
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Credential | DO
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Telephone | 615-446-2020
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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 |
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License Number State |
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