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General NPI Number Information
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NPI Number | 1487010674
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Entity Type | Organization
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Legal Business Name | MALLARD EYE CARE, LLC
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Dates
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Enumeration Date | 01/05/2016
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Last Update Date | 01/23/2020
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Provider Practice Location Address
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Address Line | 2200 BROOKMEADE DR
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City | COLUMBIA
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State | TN
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Zip | 38401-3994
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Country | US
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Telephone | 931-381-3900
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Fax |
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Provider Business Mailing Address
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Address Line | 2200 BROOKMEADE DR
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City | COLUMBIA
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State | TN
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Zip | 38401-3994
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Country | US
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Telephone | 931-381-3900
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHRISTOPHER MALLARD
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Credential | OD
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Telephone | 615-302-4477
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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 | 2955
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License Number State | TN
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