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General NPI Number Information
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NPI Number | 1790732519
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Entity Type | Organization
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Legal Business Name | EYECARE PLUS CA,PLLC
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 08/05/2021
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Provider Practice Location Address
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Address Line | 816 S JAMES CAMPBELL BLVD
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City | COLUMBIA
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State | TN
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Zip | 38401-4338
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Country | US
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Telephone | 931-540-2445
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Fax |
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Provider Business Mailing Address
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Address Line | 816 S JAMES CAMPBELL BLVD
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City | COLUMBIA
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State | TN
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Zip | 38401-4338
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Country | US
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Telephone | 931-540-2445
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Fax |
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Authorized Official
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Title or Position | CREDENTAILING MANAGER
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Name | CHEYANNE MULLIS
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Credential |
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Telephone | 615-988-5303
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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 | TN1920
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License Number State | TN
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