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General NPI Number Information
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NPI Number | 1407908114
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Entity Type | Individual
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Provider Name | RACHEL SHARP WYATT O.D.
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Gender | Female
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 560 W POPLAR AVE
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City | COLLIERVILLE
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State | TN
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Zip | 38017-6507
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Country | US
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Telephone | 901-854-3937
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Fax | 901-854-0439
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Provider Business Mailing Address
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Address Line | 89 DANA LN.
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City | BRIGHTON
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State | TN
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Zip | 38011
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Country | US
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Telephone | 901-262-6943
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Fax | 901-854-0439
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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 | 2471
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License Number State | TN
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