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General NPI Number Information
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NPI Number | 1811731110
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Entity Type | Organization
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Legal Business Name | FRED R SHANKS O.D., L.L.C.
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Dates
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Enumeration Date | 06/21/2024
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Last Update Date | 06/25/2024
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Provider Practice Location Address
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Address Line | 412 ELYSIAN FIELDS RD
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City | NASHVILLE
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State | TN
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Zip | 37211
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Country | US
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Telephone | 615-834-8495
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Fax | 615-891-7612
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Provider Business Mailing Address
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Address Line | 412 ELYSIAN FIELDS RD
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City | NASHVILLE
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State | TN
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Zip | 37211
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Country | US
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Telephone | 615-834-8495
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Fax | 615-891-7612
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Authorized Official
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Title or Position | OWNER
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Name | FRED R SHANKS
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Credential | OD
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Telephone | 615-834-8495
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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 |
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License Number State |
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