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General NPI Number Information
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NPI Number | 1730251323
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Entity Type | Organization
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Legal Business Name | NURSING HOME EYECARE PLLC
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 12/20/2007
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Provider Practice Location Address
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Address Line | 1130 HIGHWAY 96 N
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City | FAIRVIEW
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State | TN
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Zip | 37062-2804
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Country | US
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Telephone | 615-734-9771
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Fax | 615-799-6010
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Provider Business Mailing Address
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Address Line | 1130 HIGHWAY 96 N
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City | FAIRVIEW
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State | TN
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Zip | 37062-2804
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Country | US
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Telephone | 615-734-9771
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Fax | 615-799-6010
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Authorized Official
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Title or Position | OWNER
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Name | JARROD PEACE
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Credential |
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Telephone | 615-598-0142
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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 | 2531
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License Number State | TN
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