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General NPI Number Information
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NPI Number | 1447481650
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Entity Type | Organization
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Legal Business Name | COMPLETE FAMILY EYECARE, INC.
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Dates
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Enumeration Date | 08/05/2009
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Last Update Date | 07/20/2023
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Provider Practice Location Address
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Address Line | 185 BOSWELL ST
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City | LEXINGTON
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State | TN
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Zip | 38351-1597
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Country | US
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Telephone | 731-968-5225
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Fax | 731-967-3291
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Provider Business Mailing Address
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Address Line | 185 BOSWELL ST
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City | LEXINGTON
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State | TN
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Zip | 38351-1597
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Country | US
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Telephone | 731-968-5225
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Fax | 731-967-3291
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JONATHAN SHELTON
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Credential | O.D.
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Telephone | 731-968-5225
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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 | ODT2904
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License Number State | TN
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