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General NPI Number Information
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NPI Number | 1306842729
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Entity Type | Individual
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Provider Name | WILLIAM DAVID SULLINS III O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/21/2005
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Last Update Date | 01/12/2010
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Provider Practice Location Address
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Address Line | 517 N JACKSON ST
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City | ATHENS
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State | TN
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Zip | 37303-3621
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Country | US
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Telephone | 423-745-4910
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Fax | 423-745-2230
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Provider Business Mailing Address
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Address Line | 517 N JACKSON ST
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City | ATHENS
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State | TN
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Zip | 37303-3621
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Country | US
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Telephone | 423-745-4910
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Fax | 423-745-2230
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | T1722
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License Number State | TN
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