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General NPI Number Information
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NPI Number | 1760500821
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Entity Type | Organization
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Legal Business Name | PRIMARY EYECARE GROUP, P.C.
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 205 WARD CIR
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City | BRENTWOOD
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State | TN
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Zip | 37027-7552
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Country | US
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Telephone | 615-373-0080
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Fax | 615-373-2848
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Provider Business Mailing Address
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Address Line | 205 WARD CIR
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City | BRENTWOOD
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State | TN
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Zip | 37027-7552
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Country | US
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Telephone | 615-373-0080
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Fax | 615-373-2848
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. SUSAN P LUNSFORD
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Credential |
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Telephone | 615-373-0080
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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 | OD0000001488
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License Number State | TN
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