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General NPI Number Information
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NPI Number | 1467625533
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Entity Type | Organization
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Legal Business Name | DOWNTOWN VISION CENTER, P.C.
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Dates
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Enumeration Date | 04/09/2008
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Last Update Date | 07/19/2023
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Provider Practice Location Address
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Address Line | 1239 VANN DR
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City | JACKSON
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State | TN
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Zip | 38305-6024
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Country | US
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Telephone | 731-422-3811
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Fax | 731-422-5681
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Provider Business Mailing Address
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Address Line | 1239 VANN DR
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City | JACKSON
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State | TN
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Zip | 38305-6024
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Country | US
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Telephone | 731-422-3811
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Fax | 731-422-5681
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Authorized Official
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Title or Position | PRES.
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Name | DR. WILLIAM ANDREW MALEC
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Credential | O.D.
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Telephone | 731-422-3811
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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 | ODT1173
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License Number State | TN
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