=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780063156
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WHEELER EYECARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2015
-----------------------------------------------------
Last Update Date | 05/19/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 PLEASANT GROVE RD STE 600
-----------------------------------------------------
City | MOUNT JULIET
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37122-3792
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-733-5773
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 PLEASANT GROVE RD STE 600
-----------------------------------------------------
City | MOUNT JULIET
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37122-3792
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OD
-----------------------------------------------------
Name | BENJAMIN WHEELER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-733-5773
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 2780
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------