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General NPI Number Information
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NPI Number | 1740268531
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Entity Type | Individual
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Provider Name | CHARLES AVERY RICE OD
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Gender | Male
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Dates
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Enumeration Date | 01/03/2006
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Last Update Date | 11/27/2012
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Provider Practice Location Address
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Address Line | 207 WEST STATE LINE
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City | SOUTH FULTON
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State | TN
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Zip | 38257
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Country | US
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Telephone | 731-479-1334
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Fax | 731-479-1334
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Provider Business Mailing Address
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Address Line | PO BOX 5200 207 WEST STATELINE
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City | SOUTH FULTON
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State | TN
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Zip | 38257
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Country | US
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Telephone | 731-479-1334
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Fax | 431-479-1334
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 0662
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0831DT
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License Number State | KY
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