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General NPI Number Information
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NPI Number | 1598955999
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Entity Type | Organization
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Legal Business Name | JEREMY AND SUMMER ANDERSON
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Dates
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Enumeration Date | 07/31/2007
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Last Update Date | 09/25/2007
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Provider Practice Location Address
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Address Line | 1911 MCARTHUR ST
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City | MANCHESTER
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State | TN
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Zip | 37355-2688
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Country | US
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Telephone | 931-728-1315
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Fax | 931-728-1779
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Provider Business Mailing Address
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Address Line | 1911 MCARTHUR ST
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City | MANCHESTER
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State | TN
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Zip | 37355-2688
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Country | US
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Telephone | 931-728-1315
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Fax | 931-728-1779
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEREMY W ANDERSON
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Credential | O.D.
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Telephone | 931-728-1315
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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