=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427228188
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRIAN B DUBES OD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2008
-----------------------------------------------------
Last Update Date | 10/26/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1341 N MAIN ST STE 1
-----------------------------------------------------
City | CROSSVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38555-6089
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-484-6546
-----------------------------------------------------
Fax | 931-484-4855
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 451 EXECUTIVE MEADOWS DR
-----------------------------------------------------
City | LENOIR CITY
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37771-6781
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-660-0036
-----------------------------------------------------
Fax | 931-484-4855
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. BRIAN B DUBES
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 865-660-0036
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 2253
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------