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General NPI Number Information
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NPI Number | 1659604189
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Entity Type | Organization
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Legal Business Name | DR FRED DAVIS AND ASSOCIATES
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Dates
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Enumeration Date | 09/16/2009
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Last Update Date | 09/16/2009
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Provider Practice Location Address
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Address Line | 615 S CUMBERLAND ST
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City | LEBANON
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State | TN
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Zip | 37087-5107
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Country | US
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Telephone | 615-449-9000
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Fax | 615-444-5940
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Provider Business Mailing Address
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Address Line | 615 S CUMBERLAND ST
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City | LEBANON
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State | TN
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Zip | 37087-5107
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Country | US
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Telephone | 615-449-9000
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Fax | 615-444-5940
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MISS JOLENE M HENDRICKSON
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Credential |
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Telephone | 615-449-9000
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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 | 1177
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License Number State | TN
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