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General NPI Number Information
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NPI Number | 1427224781
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Entity Type | Organization
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Legal Business Name | HUDDLESTON AND SHEPHERD FAMILY VISION
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Dates
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Enumeration Date | 05/06/2008
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Last Update Date | 05/06/2008
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Provider Practice Location Address
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Address Line | 45 N DIXIE AVE
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City | COOKEVILLE
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State | TN
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Zip | 38501-3372
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Country | US
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Telephone | 931-526-2022
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Fax | 931-528-1230
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Provider Business Mailing Address
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Address Line | 45 N DIXIE AVE
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City | COOKEVILLE
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State | TN
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Zip | 38501-3372
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Country | US
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Telephone | 931-526-2022
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Fax | 931-528-1230
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KAREN DELOACH
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Credential |
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Telephone | 931-526-2022
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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 | ODT853
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License Number State | TN
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