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General NPI Number Information
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NPI Number | 1598808909
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Entity Type | Organization
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Legal Business Name | TULLAHOMA VISION ASSOCIATES P C
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 03/20/2009
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Provider Practice Location Address
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Address Line | 105 W BLACKWELL ST
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City | TULLAHOMA
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State | TN
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Zip | 37388-3555
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Country | US
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Telephone | 931-455-0654
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Fax | 931-455-0669
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Provider Business Mailing Address
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Address Line | 105 W BLACKWELL ST
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City | TULLAHOMA
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State | TN
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Zip | 37388-3555
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Country | US
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Telephone | 931-455-0654
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Fax | 931-455-0669
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMES SHAWN MCBRIDE
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Credential | O.D.
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Telephone | 931-455-0654
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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 |
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License Number State |
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