=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669545448
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAMILTON VILLAGE EYE CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2006
-----------------------------------------------------
Last Update Date | 03/06/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2020 GUNBARREL RD SUITE 100 E
-----------------------------------------------------
City | CHATTANOOGA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37421-2679
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-899-9125
-----------------------------------------------------
Fax | 423-899-9030
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2020 GUNBARREL RD SUITE 100 E
-----------------------------------------------------
City | CHATTANOOGA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37421-2679
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-899-9125
-----------------------------------------------------
Fax | 423-899-9030
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST
-----------------------------------------------------
Name | BRETT DAVID MCDONOUGH
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 423-899-9125
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 1825
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------