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General NPI Number Information
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NPI Number | 1538344353
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Entity Type | Organization
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Legal Business Name | PRIMARY EYECARE GROUP OF COLUMBIA PLLC
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Dates
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Enumeration Date | 12/31/2007
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Last Update Date | 06/13/2013
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Provider Practice Location Address
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Address Line | 1227 HATCHER LN
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City | COLUMBIA
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State | TN
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Zip | 38401-3531
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Country | US
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Telephone | 931-388-3604
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Fax | 931-388-9515
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Provider Business Mailing Address
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Address Line | 1227 HATCHER LN
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City | COLUMBIA
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State | TN
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Zip | 38401-3531
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Country | US
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Telephone | 931-388-3604
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Fax | 931-388-9515
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | VICTORIA G YOUNG
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Credential | O.D.
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Telephone | 931-388-3604
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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 | OD 0000001656
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License Number State | TN
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