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General NPI Number Information
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NPI Number | 1700816949
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Entity Type | Organization
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Legal Business Name | FAIRBANKS OCULAR PROSTHETICS, INC.
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1720 WEST END AVE SUITE 402
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City | NASHVILLE
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State | TN
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Zip | 37203
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Country | US
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Telephone | 615-322-9940
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Fax | 615-320-0970
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Provider Business Mailing Address
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Address Line | 1720 WEST END AVE SUITE 402
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City | NASHVILLE
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State | TN
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Zip | 37203
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Country | US
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Telephone | 615-322-9940
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Fax | 615-320-0970
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. STEPHEN E SANDERS
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Credential | B.C.O., BADO
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Telephone | 615-322-9940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1700X
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Taxonomy Name | Ocularist
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License Number | 05-311-11
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License Number State | TN
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