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General NPI Number Information
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NPI Number | 1528233764
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Entity Type | Organization
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Legal Business Name | KENNETH W. NIX, O.D.
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Dates
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Enumeration Date | 04/29/2008
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Last Update Date | 04/29/2008
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Provider Practice Location Address
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Address Line | 15247 RANKIN AVE
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City | DUNLAP
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State | TN
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Zip | 37327
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Country | US
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Telephone | 423-949-3937
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Fax | 423-949-7435
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Provider Business Mailing Address
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Address Line | PO BOX 1449
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City | DUNLAP
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State | TN
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Zip | 37327-1449
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Country | US
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Telephone | 423-949-3937
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Fax | 423-949-7435
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. ANN VANDYKEN
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Credential |
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Telephone | 423-949-3937
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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 | ODT617
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License Number State | TN
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