=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285860437
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BILLINGSLEY EYE CARE CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2009
-----------------------------------------------------
Last Update Date | 06/18/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 845 TURNER ST
-----------------------------------------------------
City | MARYVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37801-3595
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-681-3937
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 845 TURNER ST
-----------------------------------------------------
City | MARYVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37801-3595
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-681-3937
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. SHARON M. BILLINGSLEY
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 865-681-3937
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | ODT 1436
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------