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General NPI Number Information
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NPI Number | 1548394703
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Entity Type | Individual
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Provider Name | JIMMY EARL CRITTENDEN OPTICIAN
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Gender | Male
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1281 BATTLEFIELD PKWY
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City | FORT OGLETHORPE
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State | GA
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Zip | 30742-4009
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Country | US
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Telephone | 706-861-7053
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Fax |
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Provider Business Mailing Address
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Address Line | 1413 DOSSETT ST
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City | ATHENS
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State | TN
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Zip | 37303-4455
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Country | US
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Telephone | 423-746-8806
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | LDO000424
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License Number State | GA
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