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General NPI Number Information
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NPI Number | 1518467778
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Entity Type | Organization
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Legal Business Name | K&M OPTICAL
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Dates
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Enumeration Date | 02/14/2018
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Last Update Date | 02/14/2018
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Provider Practice Location Address
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Address Line | 73 WHITE BRIDGE RD STE 105
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City | NASHVILLE
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State | TN
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Zip | 37205-1444
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Country | US
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Telephone | 615-353-0434
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Fax | 615-352-6080
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Provider Business Mailing Address
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Address Line | 73 WHITE BRIDGE RD STE 105
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City | NASHVILLE
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State | TN
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Zip | 37205-1444
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Country | US
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Telephone | 615-353-0434
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Fax | 615-352-6080
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | SAMANTHA PERRONE
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Credential |
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Telephone | 931-436-0555
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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 | 2719
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License Number State | TN
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