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General NPI Number Information
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NPI Number | 1235256512
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Entity Type | Organization
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Legal Business Name | SITES VISION CLINIC
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 05/02/2011
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Provider Practice Location Address
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Address Line | 621 N RIVERSIDE DR
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City | CLARKSVILLE
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State | TN
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Zip | 37040-3127
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Country | US
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Telephone | 931-647-5237
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Fax | 931-647-5254
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Provider Business Mailing Address
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Address Line | 621 N RIVERSIDE DR
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City | CLARKSVILLE
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State | TN
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Zip | 37040-3127
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Country | US
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Telephone | 931-647-5237
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Fax | 931-647-5254
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. BRIAN ROY MURRAY
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Credential | OPTOMETRIST
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Telephone | 931-647-5237
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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 | ODT1759
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License Number State | TN
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