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General NPI Number Information
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NPI Number | 1811186059
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Entity Type | Individual
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Provider Name | MIA J GUILLORY O.D.
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Gender | Female
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Dates
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Enumeration Date | 10/23/2007
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Last Update Date | 11/05/2025
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Provider Practice Location Address
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Address Line | 1855 TANNER WAY STE 120
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City | HARRIMAN
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State | TN
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Zip | 37748-8332
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Country | US
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Telephone | 865-882-1535
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Fax | 865-882-9497
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Provider Business Mailing Address
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Address Line | 90 VERMONT AVE
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City | OAK RIDGE
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State | TN
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Zip | 37830-6474
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Country | US
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Telephone | 865-882-1535
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Fax | 865-882-9497
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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 | 3495
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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 | 1543
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046010059
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License Number State | IL
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