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General NPI Number Information
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NPI Number | 1619926359
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Entity Type | Organization
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Legal Business Name | OPTICAL INVESTMENT INC.
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Dates
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Enumeration Date | 05/09/2006
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Last Update Date | 12/17/2010
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Provider Practice Location Address
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Address Line | 840 HATCHER LN
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City | COLUMBIA
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State | TN
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Zip | 38401-3528
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Country | US
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Telephone | 931-381-4911
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Fax | 931-381-0966
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Provider Business Mailing Address
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Address Line | 840 HATCHER LN
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City | COLUMBIA
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State | TN
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Zip | 38401-3528
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Country | US
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Telephone | 931-381-4911
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Fax | 931-381-0966
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Authorized Official
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Title or Position | PRESIDENT/OPTOMETRIST
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Name | DR. STAN M. DICKERSON
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Credential | O.D.
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Telephone | 931-381-4911
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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 | ODT612
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License Number State | TN
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