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General NPI Number Information
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NPI Number | 1578970182
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Entity Type | Individual
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Provider Name | STEPHEN GRANT ALLEN O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/15/2014
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Last Update Date | 07/25/2014
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Provider Practice Location Address
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Address Line | 610 HENSLEE DR
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City | DICKSON
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State | TN
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Zip | 37055-1211
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Country | US
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Telephone | 615-446-2020
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Fax | 615-441-2020
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Provider Business Mailing Address
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Address Line | 610 HENSLEE DR
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City | DICKSON
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State | TN
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Zip | 37055-1211
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Country | US
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Telephone | 615-446-2020
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Fax | 615-441-2020
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OD0000003200
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License Number State | TN
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