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General NPI Number Information
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NPI Number | 1396369336
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Entity Type | Individual
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Provider Name | CALLIE MASHBURN OD
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Gender | Female
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Dates
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Enumeration Date | 06/05/2020
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 689A NEW HIGHWAY 68
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City | SWEETWATER
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State | TN
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Zip | 37874-1911
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Country | US
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Telephone | 423-337-9222
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Fax |
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Provider Business Mailing Address
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Address Line | 423 GLENLOCK RD
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City | SWEETWATER
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State | TN
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Zip | 37874-5633
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Country | US
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Telephone | 423-519-8085
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Fax |
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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 | 3600
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License Number State | TN
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