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General NPI Number Information
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NPI Number | 1629560438
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Entity Type | Organization
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Legal Business Name | DR GARRETT C SHEPHERD
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Dates
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Enumeration Date | 06/06/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 45 N DIXIE AVE
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City | COOKEVILLE
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State | TN
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Zip | 38501
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Country | US
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Telephone | 931-526-2022
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Fax | 931-528-1230
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Provider Business Mailing Address
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Address Line | 45 N DIXIE AVE
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City | COOKEVILLE
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State | TN
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Zip | 38501-3372
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Country | US
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Telephone | 931-526-2022
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Fax | 931-528-1230
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Authorized Official
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Title or Position | OWNER, DOCTOR
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Name | GARRETT C SHEPHERD
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Credential | OD
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Telephone | 931-526-2022
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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 | 2600
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License Number State | TN
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